The Global Theranostics Access Gap: Real-World Disparities in PSMA PET/CT and ¹⁷⁷Lu-PSMA Therapy Between Centers in Brazil and Europe.

Abstract

Real-world disparities in access to PSMA-targeted theranostics are poorly characterized. We compared waiting times for PSMA PET/CT and ¹⁷⁷Lu-PSMA therapy between centers in Brazil and Europe. <b>Methods:</b> This retrospective multicenter study included 91 patients (50 from Brazil, 41 from Europe) treated with ¹⁷⁷Lu-PSMA. Outcomes were days from request to PSMA PET/CT completion (diagnostic access) and days from request to first therapy dose (therapeutic access). Groups were compared using the Mann-Whitney <i>U</i> test. <b>Results:</b> Diagnostic access was similar between Brazil (median, 17.5 d; interquartile range [IQR], 9-34 d) and Europe (median, 19 d; IQR, 14-23 d; <i>P</i> = 0.39). Therapeutic access was significantly delayed in Brazil (median, 59 d; IQR, 54.5-91) compared with Europe (median, 21 d; IQR, 17-31 d; <i>P</i> < 0.01), representing a 2.8-fold longer wait. <b>Conclusion:</b> Despite comparable access to PSMA PET/CT, initiation of ¹⁷⁷Lu-PSMA therapy is nearly 3 times slower in Brazil than in Europe. Closing the therapeutic access gap requires targeted investments in radiopharmaceutical supply chains and regulatory efficiency.