Australia ‘leads world’ with Medicare funding for PET/CT prostate cancer imaging

Expanded Medicare funding for PET/CT scans means Australia is now “leading the world” when it comes to prostate cancer imaging, a senior clinician has declared.

Dr Nathan Lawrentschuk says Australia was the first country to fund pre-biopsy mpMRI scans for patient who wished to undergo active surveillance and has now followed this with funding for  PSMA PET-CT for cancer staging.

The first of the two items added to the MBS on Friday 1 July fund whole-body PSMA PET studies for the initial staging of prostate adenocarcinoma, for a previously untreated patient who is considered suitable for locoregional therapy with curative intent.

The other covers the same study for patients with recurrent disease considered suitable locoregional therapy, restricted to patients with prostate specific antigen (PSA) increase of 2ng/ml above the nadir after radiation therapy.

Patients in whom PSA levels have failed to fall to undetectable levels or with rising PSA serum after a radical prostatectomy will also be eligible – for a maximum of twice in their lifetime.

Health officials have stressed neither item can be used for surveillance, nor for assessment of patients with suspected (as opposed to confirmed) prostate adenocarcinoma or disease recurrence.

But the move will regardless change practice and deliver better care for patients with prostate cancer, says Dr Lawrentschuk, a urologist and researcher on the proPSMA study which formed the basis for the new items.

Writing in BJUI International, he said Australia had already been ahead of the curve thanks to Federal Government funding for pre-biopsy multiparametric MRI (mpMRI) scans in 2018, which had helped avoid overdiagnosis and overtreatment of prostate cancer.

The new MBS items meant Australia was “again leading the world”, Dr Lawrentschuk said.

“Again, we are leading the way in funding of appropriate investigations in men with suspected or known prostate cancer. Again, we wait for the rest of the world to catch up.”

The Director of Urology at the Royal Melbourne Hospital and Director of the EJ Whitten Prostate Cancer Research Centre at Epworth Hospital said mpMRI was “pretty good but not perfect”.

While mpMRI had resulted in a significant fall in prostate biopsy rates, PSMA PET-CT would have a further impact, Dr Lawrentschuk.

“The number of conventional staging scans being CT and bone scans will diminish,” he wrote.

“Treatment decisions will change based upon superior staging.”

“It will be interesting to observe if patterns of care change with the funding of PSMA PET-CT scans and what savings will be generated across medical care in Australia.”


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