{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:17:33Z","timestamp":1789496253660,"version":"build-2803163510"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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\u20135, 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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 \u20ac170-\u20ac186 per patient and an incremental cost-effectiveness ratio (ICER) of \u20ac56,700-\u20ac93,212 per QALY. In PI-RADS 1\u20132, 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 \u20ac416-\u20ac429 per patient and was thus not cost-effective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00259-025-07190-6","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T07:32:32Z","timestamp":1741764752000},"page":"3159-3169","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["A cost-effectiveness study of PSMA-PET\/CT for the detection of clinically significant prostate cancer"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-9117","authenticated-orcid":false,"given":"Bastiaan M.","family":"Priv\u00e9","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim M.","family":"Govers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Isra\u00ebl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel J. R.","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart J. R.","family":"Timmermans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffie M. B.","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"de Groot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Z\u00e1mecnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stan R. W.","family":"Wijn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hoepping","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. P. Michiel","family":"Sedelaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle O.","family":"Barentsz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge M.","family":"van Oort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"de Rooij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Nagarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"7190_CR1","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.eururo.2019.08.005","volume":"77","author":"MB Culp","year":"2020","unstructured":"Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol. 2020;77:38\u201352. https:\/\/doi.org\/10.1016\/j.eururo.2019.08.005.","journal-title":"Eur Urol"},{"key":"7190_CR2","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1001\/jamaoncol.2022.7826","volume":"9","author":"S Chen","year":"2023","unstructured":"Chen S, Cao Z, Prettner K, Kuhn M, Yang J, Jiao L, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol. 2023;9:465\u201372. https:\/\/doi.org\/10.1001\/jamaoncol.2022.7826.","journal-title":"JAMA Oncol"},{"key":"7190_CR3","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.eururo.2015.04.023","volume":"68","author":"L Bourke","year":"2015","unstructured":"Bourke L, Boorjian SA, Briganti A, Klotz L, Mucci L, Resnick MJ, et al. Survivorship and improving quality of life in men with prostate cancer. Eur Urol. 2015;68:374\u201383. https:\/\/doi.org\/10.1016\/j.eururo.2015.04.023.","journal-title":"Eur Urol"},{"key":"7190_CR4","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1056\/NEJMoa2100852","volume":"385","author":"M Eklund","year":"2021","unstructured":"Eklund M, J\u00e4derling F, Discacciati A, Bergman M, Annerstedt M, Aly M, et al. MRI-targeted or standard biopsy in prostate cancer screening. N Engl J Med. 2021;385:908\u201320. https:\/\/doi.org\/10.1056\/NEJMoa2100852.","journal-title":"N Engl J Med"},{"key":"7190_CR5","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","volume":"378","author":"V Kasivisvanathan","year":"2018","unstructured":"Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767\u201377. https:\/\/doi.org\/10.1056\/NEJMoa1801993.","journal-title":"N Engl J Med"},{"key":"7190_CR6","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.euo.2021.09.006","volume":"4","author":"G Gandaglia","year":"2021","unstructured":"Gandaglia G, Leni R, Bray F, Fleshner N, Freedland SJ, Kibel A, et al. Epidemiology and prevention of prostate cancer. Eur Urol Oncol. 2021;4:877\u201392. https:\/\/doi.org\/10.1016\/j.euo.2021.09.006.","journal-title":"Eur Urol Oncol"},{"key":"7190_CR7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.eururo.2017.08.018","volume":"73","author":"R Faria","year":"2018","unstructured":"Faria R, Soares MO, Spackman E, Ahmed HU, Brown LC, Kaplan R, et al. Optimising the diagnosis of prostate cancer in the era of multiparametric magnetic resonance imaging: a cost-effectiveness analysis based on the prostate MR imaging study (PROMIS). Eur Urol. 2018;73:23\u201330. https:\/\/doi.org\/10.1016\/j.eururo.2017.08.018.","journal-title":"Eur Urol"},{"key":"7190_CR8","doi-asserted-by":"publisher","first-page":"e2344856","DOI":"10.1001\/jamanetworkopen.2023.44856","volume":"6","author":"H Yun","year":"2023","unstructured":"Yun H, Kim J, Gandhe A, Nelson B, Hu JC, Gulani V, et al. Cost-effectiveness of annual prostate MRI and potential MRI-guided biopsy after prostate-specific antigen test results. JAMA Network Open. 2023;6:e2344856. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.44856.","journal-title":"JAMA Network Open."},{"key":"7190_CR9","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/s0140-6736(20)30314-7","volume":"395","author":"MS Hofman","year":"2020","unstructured":"Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395:1208\u201316. https:\/\/doi.org\/10.1016\/s0140-6736(20)30314-7.","journal-title":"Lancet"},{"key":"7190_CR10","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.eururo.2020.09.042","volume":"79","author":"N Mottet","year":"2021","unstructured":"Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79:243\u201362. https:\/\/doi.org\/10.1016\/j.eururo.2020.09.042.","journal-title":"Eur Urol."},{"key":"7190_CR11","doi-asserted-by":"publisher","unstructured":"Emmett L, Buteau J, Papa N, Moon D, Thompson J, Roberts MJ, et al. The additive diagnostic value of prostate-specific membrane antigen positron emission tomography computed tomography to multiparametric magnetic resonance imaging triage in the diagnosis of prostate cancer (PRIMARY): a prospective multicentre study. Eur Urol. https:\/\/doi.org\/10.1016\/j.eururo.2021.08.002.","DOI":"10.1016\/j.eururo.2021.08.002."},{"key":"7190_CR12","doi-asserted-by":"publisher","first-page":"e231879","DOI":"10.1148\/radiol.231879","volume":"311","author":"BM Priv\u00e9","year":"2024","unstructured":"Priv\u00e9 BM, Isra\u00ebl B, Janssen MJR, Leest MMG, Rooij M, Ipenburg JA, et al. Multiparametric MRI and 18F-PSMA-1007 PET\/CT for the detection of clinically significant prostate cancer. Radiology. 2024;311:e231879. https:\/\/doi.org\/10.1148\/radiol.231879.","journal-title":"Radiology."},{"key":"7190_CR13","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.eururo.2019.06.023","volume":"77","author":"FH Drost","year":"2020","unstructured":"Drost FH, Osses D, Nieboer D, Bangma CH, Steyerberg EW, Roobol MJ, et al. Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: a cochrane systematic review and meta-analysis. Eur Urol. 2020;77:78\u201394. https:\/\/doi.org\/10.1016\/j.eururo.2019.06.023.","journal-title":"Eur Urol"},{"key":"7190_CR14","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1001\/jama.280.11.969","volume":"280","author":"AV D'Amico","year":"1998","unstructured":"D\u2019Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280:969\u201374. https:\/\/doi.org\/10.1001\/jama.280.11.969.","journal-title":"JAMA"},{"key":"7190_CR15","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1038\/s41585-022-00648-4","volume":"20","author":"T Barrett","year":"2023","unstructured":"Barrett T, de Rooij M, Giganti F, Allen C, Barentsz JO, Padhani AR. Quality checkpoints in the MRI-directed prostate cancer diagnostic pathway. Nat Rev Urol. 2023;20:9\u201322. https:\/\/doi.org\/10.1038\/s41585-022-00648-4.","journal-title":"Nat Rev Urol"},{"key":"7190_CR16","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1148\/radiol.2020190646","volume":"296","author":"AC Westphalen","year":"2020","unstructured":"Westphalen AC, McCulloch CE, Anaokar JM, Arora S, Barashi NS, Barentsz JO, et al. Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: experience of the society of abdominal radiology prostate cancer disease-focused panel. Radiology. 2020;296:76\u201384. https:\/\/doi.org\/10.1148\/radiol.2020190646.","journal-title":"Radiology"},{"key":"7190_CR17","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1016\/S1470-2045(20)30751-8","volume":"22","author":"H Hricak","year":"2021","unstructured":"Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, et al. Medical imaging and nuclear medicine: a <em>Lancet Oncology<\/em> Commission. Lancet Oncol. 2021;22:e136\u201372. https:\/\/doi.org\/10.1016\/S1470-2045(20)30751-8.","journal-title":"Lancet Oncol"},{"key":"7190_CR18","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.radonc.2022.10.028","volume":"177","author":"J Evers","year":"2022","unstructured":"Evers J, Kerkmeijer LGW, van den Bergh RCN, van der Sangen MJC, Hulshof M, Bloemers M, et al. Trends and variation in the use of radiotherapy in non-metastatic prostate cancer: A 12-year nationwide overview from the Netherlands. Radiother Oncol. 2022;177:134\u201342. https:\/\/doi.org\/10.1016\/j.radonc.2022.10.028.","journal-title":"Radiother Oncol"},{"key":"7190_CR19","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1016\/j.juro.2014.04.098","volume":"192","author":"KJ Lundstr\u00f6m","year":"2014","unstructured":"Lundstr\u00f6m KJ, Drevin L, Carlsson S, Garmo H, Loeb S, Stattin P, et al. Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol. 2014;192:1116\u201322. https:\/\/doi.org\/10.1016\/j.juro.2014.04.098.","journal-title":"J Urol"},{"key":"7190_CR20","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1111\/j.1464-410X.2012.11597.x","volume":"111","author":"MR Cooperberg","year":"2013","unstructured":"Cooperberg MR, Ramakrishna NR, Duff SB, Hughes KE, Sadownik S, Smith JA, et al. Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis. BJU Int. 2013;111:437\u201350. https:\/\/doi.org\/10.1111\/j.1464-410X.2012.11597.x.","journal-title":"BJU Int"},{"key":"7190_CR21","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.1002\/cncr.29983","volume":"122","author":"GA Viani","year":"2016","unstructured":"Viani GA, Viana BS, Martin JE, Rossi BT, Zuliani G, Stefano EJ. Intensity-modulated radiotherapy reduces toxicity with similar biochemical control compared with 3-dimensional conformal radiotherapy for prostate cancer: A randomized clinical trial. Cancer. 2016;122:2004\u201311. https:\/\/doi.org\/10.1002\/cncr.29983.","journal-title":"Cancer"},{"key":"7190_CR22","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1038\/s41443-022-00555-7","volume":"34","author":"GM Gryzinski","year":"2022","unstructured":"Gryzinski GM, Bernie HL. Testosterone deficiency and the aging male. Int J Impot Res. 2022;34:630\u20134. https:\/\/doi.org\/10.1038\/s41443-022-00555-7.","journal-title":"Int J Impot Res"},{"key":"7190_CR23","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1007\/s40273-022-01191-1","volume":"40","author":"E Keeney","year":"2022","unstructured":"Keeney E, Sanghera S, Martin RM, Gulati R, Wiklund F, Walsh EI, et al. Cost-effectiveness analysis of prostate cancer screening in the UK: A decision model analysis based on the CAP trial. Pharmacoeconomics. 2022;40:1207\u201320. https:\/\/doi.org\/10.1007\/s40273-022-01191-1.","journal-title":"Pharmacoeconomics"},{"key":"7190_CR24","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/01.mlr.0000156862.33341.45","volume":"43","author":"ST Stewart","year":"2005","unstructured":"Stewart ST, Lenert L, Bhatnagar V, Kaplan RM. Utilities for prostate cancer health states in men aged 60 and older. Med Care. 2005;43:347\u201355. https:\/\/doi.org\/10.1097\/01.mlr.0000156862.33341.45.","journal-title":"Med Care"},{"key":"7190_CR25","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1056\/NEJMoa1201637","volume":"367","author":"EA Heijnsdijk","year":"2012","unstructured":"Heijnsdijk EA, Wever EM, Auvinen A, Hugosson J, Ciatto S, Nelen V, et al. Quality-of-life effects of prostate-specific antigen screening. N Engl J Med. 2012;367:595\u2013605. https:\/\/doi.org\/10.1056\/NEJMoa1201637.","journal-title":"N Engl J Med"},{"key":"7190_CR26","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.2214\/ajr.16.17322","volume":"208","author":"W Venderink","year":"2017","unstructured":"Venderink W, Govers TM, de Rooij M, F\u00fctterer JJ, Sedelaar JPM. Cost-effectiveness comparison of imaging-guided prostate biopsy techniques: systematic transrectal ultrasound, direct in-bore MRI, and image fusion. AJR Am J Roentgenol. 2017;208:1058\u201363. https:\/\/doi.org\/10.2214\/ajr.16.17322.","journal-title":"AJR Am J Roentgenol"},{"key":"7190_CR27","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1056\/NEJMoa1615869","volume":"377","author":"TJ Wilt","year":"2017","unstructured":"Wilt TJ, Jones KM, Barry MJ, Andriole GL, Culkin D, Wheeler T, et al. Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med. 2017;377:132\u201342. https:\/\/doi.org\/10.1056\/NEJMoa1615869.","journal-title":"N Engl J Med"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07190-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-025-07190-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07190-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T05:52:35Z","timestamp":1751435555000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00259-025-07190-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":27,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["7190"],"URL":"https:\/\/doi.org\/10.1007\/s00259-025-07190-6","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]},"assertion":[{"value":"7 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"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.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"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.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}