Diagnostic Accuracy of <sup>68</sup>Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis

Satapathy, Sujata; Singh, Harmandeep; Kumar, Rajender; Mittal, Bhagwant Rai

doi:10.2214/ajr.20.23912

Cited by 61 publications

(46 citation statements)

References 26 publications

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“…PSMA PET/CT is a sensitive imaging technique with superior diagnostic accuracy over conventional imaging (CT and bone scan) for staging prostate cancer [ 4 , 5 ]. PSMA PET/CT has a higher sensitivity (97%) and lower specificity (66%) compared to multiparametric MRI (mpMRI) (sensitivity 87% and specificity 68%) and choline PET/CT (sensitivity 73% and specificity 88%) for initial staging of prostate cancer [ 6 , 7 ]. With biochemical recurrence, PSMA PET/CT has a higher disease detection rate than choline PET/CT and mpMRI.…”

Section: Introductionmentioning

confidence: 99%

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

et al. 2021

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Background Accurate prostate cancer imaging is critical for patient management. Multiple studies have demonstrated superior diagnostic accuracy of [68Ga]-PSMA-11 PET/CT over conventional imaging for disease detection, with validated clinical and biochemical predictors of disease detection. More recently [18F]PSMA-1007 offers theoretical imaging advantages, but there is limited evidence of clinical and biochemical predictors of scan findings in the staging population. This study investigates the association of clinical variables with imaging characteristics among patients who underwent [18F]PSMA-1007 PET/CT for primary staging of men with histopathologically confirmed prostate carcinoma. A retrospective review of 194 consecutive patients imaged between May 2019 to May 2020 was performed. Association between imaging variables (presence and distribution of metastatic disease, primary tumour SUVmax) and clinical variables (EAU risk criteria) were assessed using descriptive statistics, logistic regression model and ROC analysis. Results The median age, PSA level and ISUP grade were 70 years, 10 ng/mL and ISUP grade 3, respectively. There were 36.6% of patients with intermediate-risk and 60.8% of patients with high-risk disease. ISUP grade was associated with the presence of metastasis overall (p = 0.008) as well as regional nodal (p = 0.003), non-regional nodal (p = 0.041) and bone (p = 0.006) metastases. PSA level was associated with metastatic disease overall (p = 0.001), regional (p = 0.001) and non-regional nodal metastases (p = 0.004), but not with bone metastases (p = 0.087). There were too few visceral metastases for meaningful analysis. SUVmax of the primary prostatic tumour was associated with ISUP grade (p = 0.004), PSA level (p < 0.001) and AJCC stage (p = 0.034). PSA > 20 ng/mL and ISUP grade > 3 had a specificity of 85% (95% CI 78–91%) and 60% (95% CI 50–68%) and a sensitivity of 36% (95% CI 25–49%) and 62% (95% CI 49–74%), respectively, for detection of metastatic disease. Conclusion Metastatic disease according to [18F]PSMA-1007 PET/CT was associated with ISUP grade and PSA level. This is the largest study using [18F]PSMA-1007 PET/CT to confirm a positive correlation of PSA level, ISUP grade and stage with primary prostate tumour SUVmax.

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Section: Introductionmentioning

confidence: 99%

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

et al. 2021

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“…Ga-68 PSMA PET/CT showed excellent sensitivity and negative likelihood ratio to detect suspected prostate cancer and has potential utility as a “rule-out” test in this. [ 10 ] However, our study shows a good specificity also in addition to sensitivity and accuracy. Although, in our study, MRI showed a higher sensitivity as one case of carcinoma prostate was missed on PSMA PET/CT.…”

Section: Discussionmentioning

confidence: 58%

“…[ 9 ] A recent meta-analysis by Satapathy et al . [ 10 ] evaluated the diagnostic performance of Ga-68 PSMA PET/CT in the initial detection of prostate cancer in patients with clinical or biochemical suspicion. Ga-68 PSMA PET/CT showed excellent sensitivity and negative likelihood ratio to detect suspected prostate cancer and has potential utility as a “rule-out” test in this.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

Soni

Verma

Shah

et al. 2021

Indian Journal of Nuclear Medicine

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Introduction: We carried out this study to compare the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) and gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-68 PSMA PET/CT) to detect prostatic carcinoma in patients with serum prostate-specific antigen (PSA) between 4 and 20 ng/ml in prebiopsy setting. Materials and Methods: This prospective study evaluated men with serum PSA values between 4 and 20 ng/ml. All patients underwent mpMRI and Ga-68 PSMA PET/CT, followed by 12-core transrectal ultrasonography (TRUS)-guided biopsy to detect prostatic carcinoma. The diagnostic accuracy of mpMRI and PSMA PET/CT scan was compared with histopathological findings. Results: There were thirty patients included in the study with a median age of 73 years (age range: 69–79 years). The median total serum PSA was 8.0 ng/ml (5.0–19.9 ng/ml). Of these, 18 had an identifiable lesion on imaging and had histopathological findings suggestive of carcinoma prostate. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were 100%, 92.30%, 94.73%, and 100%, respectively, and that of PSMA PET scan were 94.44%, 100%, 100%, and 92.31%, respectively. The diagnostic accuracy of both was 96.67%. Conclusion: PSMA PET scan showed higher PPV and specificity while mpMRI showed higher sensitivity and NPV. The accuracy in predicting presence of carcinoma was the same for both. PSMA PET showed higher specificity and PPV and predicted the subsequent need of biopsy. In our study, the NPV of PET, though good, was lower than mpMRI. Prospective trials with larger sample size are needed. In combination, PET/MRI may achieve greater accuracy and may serve as investigation of choice.

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“…PET with ligands for the prostate-specific membrane antigen (PSMA) might overcome this limitation. Indeed, PET with Gallium-68 labelled PSMA-HBED-CC (68Ga-PSMA) demonstrated superior tumor-to-background signal intensity and substantially higher detection rates in patients with primary PCa [ 9 , 10 ] and biochemical recurrence even with low total prostate-specific antigen (tPSA) levels [ 11 , 12 ]. Studies showed that in spite of additional sites of uptake being detected on PSMA-PET/CT as compared to mpMRI, no additional biopsies are required [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Role of 68Ga-PSMA-PET/CT for the detection of primary prostate cancer prior to biopsy: a prospective study

Jain

Sood

Faridi

et al. 2021

Cent european J Urol

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Introduction Prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET-CT) is widely used as a staging tool for patients with prostate cancer (PCa). The objective of the study is to assess the diagnostic accuracy of 68Ga-PSMA-PET/CT for PCa, which may help us avoid unnecessary biopsies in patients with intermediate prostate-specific antigen (PSA) levels. Material and methods In this prospective study, 81 patients suspected of PCa, with either raised PSA between 4–20 ng/ml or abnormal digital rectal examination (DRE) findings were included. 68Ga-PSMA-PET/CT was performed for all patients followed by transrectal ultrasound (TRUS) guided prostate biopsy. SUVmax (maximum standardized uptake value) was measured and correlated with biopsy results. Results Out of 81 patients, 31 (38.3%) patients were found to have malignancy on biopsy. Median SUVmax of biopsy positive patients was 10.4 (IQR 6.5–16.1) and biopsy negative patients (n=50) was 3.5 (IQR 1–4.9), (p <0.001). At a cut-off of 6.15, 68GA-PSMA-PET/CT demonstrated sensitivity of 84%, specificity of 80%, positive predictive value of 72.2%, negative predictive value of 88.9% and accuracy of 81.5% with an AUC of 0.876 (95% CI: 0.799–0.953, p <0.001). Conclusions The 68Ga-PSMA-PET/CT helps to localize suspicious lesions and improving the detection of primary prostate cancer. Our findings indicate a significant correlation of SUVmax values with biopsy results. We were also able to determine a cut-off value of SUVmax below which prostate biopsy can be avoided in selected patients.

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Diagnostic Accuracy of ⁶⁸Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis

Cited by 61 publications

References 26 publications

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

Role of 68Ga-PSMA-PET/CT for the detection of primary prostate cancer prior to biopsy: a prospective study

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Diagnostic Accuracy of 68Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis

Cited by 61 publications

References 26 publications

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

Risk of metastatic disease using [18F]PSMA-1007 PET/CT for primary prostate cancer staging

Comparison of Multiparametric Magnetic Resonance Imaging and Gallium-68 Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Detecting Carcinoma Prostate in Patients with Serum Prostate-Specific Antigen between 4 and 20 ng/ml

Role of 68Ga-PSMA-PET/CT for the detection of primary prostate cancer prior to biopsy: a prospective study

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Diagnostic Accuracy of ⁶⁸Ga-PSMA PET/CT for Initial Detection in Patients With Suspected Prostate Cancer: A Systematic Review and Meta-Analysis