IMAGING IMPLENTATION ADVICE PANEL: GUIDANCE FOR PSMA-PET IMPLEMENTATION - Introduction and Background

On March 3rd, 2023, CADTH issued a final recommendation for the conditional reimbursement of Pluvicto.5 CADTH also published a report on the infrastructural readiness of Canada’s health care system for the adoption of PSMA-PET for the staging and restaging of prostate cancer.6 The CADTH recommendation for Pluvicto stated that eligible patients should be identified based on the criteria that were u. [...] The implementation advice was developed in accordance with the CADTH Procedures for Medical Imaging Implementation Advice.9 Implementation Question At the request of the CADTH’s jurisdictional advisory committee for oncology drugs (the Provincial Advisory Group [PAG]), CADTH convened an implementation advice panel on June 19, 2023, to provide advice for addressing the following implementation ques. [...] Several studies were discussed that compared the use of 68Ga gozetotide and 18F-DCFPyL imaging using both liver reference and SUVmax methods for determining PSMA- positivity in patients.12,13 The use of the liver as a reference region is based on the VISION study,3 in which the presence of at least 1 PSMA-positive metastatic lesion was necessary for treatment eligibility, in addition to other tria. [...] Due to preferential uptake of 18F-PSMA-1007 in the liver, the panellists cautioned against using the liver as a reference organ for this agent, and instead recommended the use of a numeric detection threshold or alternative reference organ (e.g., parotids, spleen).14 The following points were expressed by the panellists regarding threshold selection for confirming PSMA-positivity (Table 2): • The. [...] The Use of Other PSMA-PET Radiopharmaceuticals Are Not Expected to Significantly Change the Patient Population Eligible for Treatment There was general agreement among the panellists that the acquisition and implementation of additional PET-PSMA radiopharmaceuticals are not anticipated to increase the patient population or number of patients eligible for Pluvicto beyond those that have been report.