ArticleCancer imaging : the official publication of the International Cancer Imaging Society2025
Geographic variability in contemporary utilization of PET imaging for prostate cancer: a medicare claims cohort study.
Article in Cancer imaging : the official publication of the International Cancer Imaging Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Artificial intelligence in urology: A review of United States Food and Drug Administration-cleared devices.BJU international · 2026Review
- Next-GenInternational journal of molecular sciences · 2026Article
- Substituting blood-based biomarkers for imaging measures in Alzheimer's disease studies: implications for sample size and bias.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026Article
- Measuring and defining screening benefit in a new era of cancer early detection.Journal of the National Cancer Institute · 2026Article
- Substituting Blood-Based Biomarkers for Imaging Measures in Alzheimer's Disease Studies: Implications for Sample Size and Bias.medRxiv : the preprint server for health sciences · 2025Article
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Abstract
backgroundPotential rural-urban differences in prostate cancer care are understudied, particularly regarding the utilization of advanced diagnostic tests. Herein we examined variations in Positron Emission Tomography (PET) utilization for prostate cancer care, including diagnosis, staging and treatment planning, across residential regions in the United States.
methodsPatients newly diagnosed with prostate cancer between 2019 and 2021 and post-diagnostic PETs were identified using full Medicare claims data. PET use was assessed in all newly diagnosed patients, though indications vary by risk. Patients' counties were categorized as metro, urban, or rural, from most to least urbanized. Regional PET utilization was further examined at the level of hospital referral regions. A multivariable logistic regression model was performed to assess the impact of rurality on PET imaging. A secondary analysis included an interaction term for race to explore the effect of residence on PET imaging by racial group.
resultsOverall, 495 865 patients were included in the analysis: 393 861 (79.4%) lived in metro, 56 698 (11.4%) in urban and 39 707 (8.0%) in rural counties. Patients in metro counties underwent PET imaging more often (8.4%) than patients in urban (7.3%) or rural counties (7.2%), p < 0.0001. At a level of hospital referral region, PET utilization rates ranged from 2.2 to 20.8%. PET imaging was more commonly performed in White compared to Black or Hispanic patients. Rural patients were less likely to undergo PET imaging compared to metro patients (odds ratio [OR] 0.87, 95% Confidence interval [CI]: 0.82-0.92 p < 0.0001). Rural Black (OR 0.69, 95%CI 0.57-0.83, p < 0.0001) and rural White patients (OR 0.89, 95%CI 0.83-0.94 p < 0.0001) were less likely to obtain PET imaging compared to their metro counterparts, p-interaction < 0.0001.
conclusionRural patients were less likely to undergo PET imaging than metro patients. The effect of rurality was most pronounced among Black patients. Our findings underscore the need for strategies to support equitable use of PET imaging.
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