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. 2025 Jul;52(9):3159-3169.
doi: 10.1007/s00259-025-07190-6. Epub 2025 Mar 12.

A cost-effectiveness study of PSMA-PET/CT for the detection of clinically significant prostate cancer

Bastiaan M Privé  1   2 , Tim M Govers  3   4 , Bas Israël  3   5   6 , Marcel J R Janssen  3 , Bart J R Timmermans  3 , Steffie M B Peters  3 , Michel de Groot  3 , Patrik Zámecnik  3 , Stan R W Wijn  4 , Alexander Hoepping  7 , J P Michiel Sedelaar  5 , Jelle O Barentsz  3   8 , Inge M van Oort  5 , Maarten de Rooij  3 , James Nagarajah  3
Affiliations

A cost-effectiveness study of PSMA-PET/CT for the detection of clinically significant prostate cancer

Bastiaan M Privé et al. Eur J Nucl Med Mol Imaging. 2025 Jul.

Abstract

Background: Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is currently under evaluation for detecting clinically significant prostate cancer. The PSMA-PET/CT may complement the current standard diagnostic pathway for prostate cancer, which includes prostate-specific antigen (PSA) testing and multiparametric magnetic resonance imaging (mpMRI). This study evaluated the cost-effectiveness and quality of life impact of incorporating PSMA-PET/CT into this diagnostic algorithm.

Methods: A life-time decision model compared the current standard of care of a MRI driven diagnostic pathway, where men undergo prostate biopsy in case of a Prostate Imaging Reporting and Data System (PI-RADS) scores 3-5, to a strategy incorporating PSMA-PET/CT to potentially avoid unnecessary biopsies. Long-term quality-adjusted life years (QALY) and healthcare costs were calculated for each approach.

Results: In PI-RADS 3 lesions, PSMA-PET/CT improved the per-patient QALY by 0.002 and was borderline cost-effective, with an increased cost of €170-€186 per patient and an incremental cost-effectiveness ratio (ICER) of €56,700-€93,212 per QALY. In PI-RADS 1-2, additional biopsies and over-detection of low-risk prostate cancers led to a per-patient QALY decrease of 0.001 points, a cost increase of €416-€429 per patient and was thus not cost-effective.

Conclusion: The addition of PSMA-PET/CT to MRI in patients with equivocal MRI findings appears to be borderline cost-effective due to biopsy avoidance and a reduced detection of indolent, low-risk tumors. In men with a negative MRI, adding a PSMA-PET/CT does not seem to be cost-effective due to a higher number of unnecessary biopsies and only minor improvement in the detection of clinically significant prostate cancer.

Keywords: Cost-effectiveness; PSA; PSMA; Prostate cancer; mpMRI.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Medical Review Ethics Committee Arnhem-Nijmegen, The Netherlands (NL73559.091.20). All study participants provided informed consent before study entry. Disclosures: B.M.P. No relevant relationships. T.G. holds stock of Medip analytics. B.I. No relevant relationships. M.J.R.J. Research grants from Novartis and ABX; payment for lectures from Sirtex. B.T. No relevant relationships. S.M.B.P. No relevant relationships. M.d.G. No relevant relationships. P.Z. Stock and stock options in SPL Medical; scientific advisor for SPL Medical. S.W. holds stock of Medip analytics. A.H. No relevant relationships. J.P.M.S. No relevant relationships. J.O.B. No relevant relationships. I.M.v.O. No relevant relationships. M.d.R. No relevant relationships. J.N. No relevant relationships.

Figures

Fig. 1
Fig. 1
Decision tree for SOC and strategy with PSMA-PET/CT. MRI = Magnetic Resonance Imaging; PI-RADS = Prostate Imaging Reporting and Data System; Pca = prostate cancer; SBx = systematic biopsy; TBx = target biopsy
Fig. 2
Fig. 2
Health state transition model
See this image and copyright information in PMC

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