Can Negative Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Avoid the Need for Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients? A Systematic Review and Meta-analysis with Backup Histology as Reference Standard

Abstract

Context: The role of positron emission tomography/computed tomography (PET/ CT) with prostate-specific membrane antigen (PSMA) in the primary staging for patients with prostate cancer (PCa) is still debated. Objective: To analyze published studies reporting the accuracy of PSMA PET/CT for detecting lymph node invasion (LNI) at pelvic lymph node dissection (PLND). Evidence acquisition: A search of PubMed/MEDLINE, Cochrane library's Central, EMBASE and Scopus databases, from inception to May 2021, was conducted. The primary outcome was to evaluate the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of PSMA PET/CT in detecting LNI on a per-patient level. As a secondary outcome, NPV of PET PSMA was tested on a per-node-level analysis. Detection rates were pooled using random-effect models. Preplanned subgroup analyses tested the diagnostic accuracy after stratification for the preoperative risk group. PPV and NPV variation over LNI prevalence was evaluated. Only studies including extended PLND (ePLND) as the reference standard test were included. Evidence synthesis: Twenty-seven studies, with a total of 2832 participants, were included in quantitative synthesis. The sensitivity, specificity, PPV, and NPV of y These authors contributed equally to this study.

The Role of PSMA PET/CT in the Primary Diagnosis and Follow-Up of Prostate Cancer—A Practical Clinical Review

“…A meta-analysis by Stabile et al aimed to evaluate whether PSMA PET/CT can avoid the need for extended pelvic lymph node dissection (ePLND) in selected patients [ 82 ]. 27 original articles (n = 2832 patients) using different PET tracers were included in the final analysis (see Table 11 ).…”

Focal therapy for prostate cancer: what is really needed to move from investigational to valid therapeutic alternative?—a narrative review

“…A recent addition to PCa imaging assessment on top of mpMRI is the use of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) to identify intra- and extra-prostatic disease localization. While currently used mostly in the setting of PCa recurrence, recent evidence suggests a potential role in the primary setting, in particular for evaluating lymph node invasion ( 22 , 23 ) and improving the detection of clinically significant prostate cancer (csPCa) when paired with mpMRI ( 22 ). In fact, recent studies are assessing the role of adding PSMA-PET to previously developed nomograms.…”

Optimization of prostate cancer patient lymph node staging via the integration of neutrophil–lymphocyte ratios, platelet–lymphocyte ratios, and 68Ga‐PSMA‐PET‐derived SUVmax values

“…68 Ga‐PSMA‐PET/CT is a recently developed imaging modality that is superior to these more traditional approaches in the context of early stage tumor detection and PCa recurrence diagnosis 9–11 . However, the utility of this approach in the context of LNS remains controversial given that negative PSMA PET/CT results cannot preclude the need for partial lymph node dissection in patients considered high‐risk 12 . Moreover, standardized quantitative approaches to evaluating 68 Ga‐PSMA‐PET/CT results are lacking at present 13 .…”

“…[9][10][11] However, the utility of this approach in the context of LNS remains controversial given that negative PSMA PET/CT results cannot preclude the need for partial lymph node dissection in patients considered high-risk. 12 Moreover, standardized quantitative approaches to evaluating 68 Ga-PSMA-PET/CT results are lacking at present. 13 Maximum standardized uptake value (SUVmax) is a semi-quantitative PET/CT parameter that exhibits favorable reproducibility 14 and has been reportedly used as a cutoff for PCa diagnosis in several studies to date.…”