Prostate-Specific Membrane Antigen PET-CT Imaging for the Staging of Prostate Cancer in Canada

Key Messages

• Health Canada approved the first prostate-specific membrane antigen (PSMA)-PET radiopharmaceutical in October 2022 for the staging of PSMA-positive lesions in those with prostate cancer. Health Canada also approved a lutetium-177 PSMA-617 therapy for patients with advanced PSMA-positive metastatic castration-resistant prostate cancer in September 2022, a therapy for which patient eligibility is identified with a gallium-68 PSMA-PET exam.
• With 57 PET-CT units in 9 provinces, access to PET-CT may be limited by the health care system’s capacity to conduct these exams due to wait lists, competing clinical priorities, and staff shortages.
• It is anticipated that the public funding of PSMA-PET across Canada will increase existing demand for PET-CT by a minimum of 23%.
• The provision of PSMA-PET would occur within the context of managing competing new demands for this service that could double existing exam volume.
• Sufficient staffing is needed to ensure sustainable operation and development of PET-CT services, supported by investment in the workforce through education and training opportunities.
• There is potential to increase the hours of operation of PET-CT units in many facilities, with consideration to the many dependencies, including staffing and the fact that the operating times of PET-CT units are closely tied to the operating times of the cyclotrons that supply the radiopharmaceuticals used in PET-CT exams.
• The upfront capital and ongoing operational costs of PET-CT, radiopharmaceutical products, and equipment may act as barriers to the further adoption of this technology.
• A combination of both generator-produced and cyclotron-produced PSMA-PET radiopharmaceuticals will likely be needed to meet the geography of Canadian jurisdictions and to secure a reliable and resilient supply chain.