Diagnostic Performance of ⁶⁸Gallium Labelled Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging for Staging the Prostate Cancer with Intermediate or High Risk Prior to Radical Prostatectomy: A Systematic Review and Meta-analysis

Abstract

Purpose: To compare the diagnostic efficiency of 68 Gallium labelled prostate-specific membrane antigen positron emission tomography (68 Ga-PSMA PET) and magnetic resonance imaging (MRI) for staging the lymph node metastases (LNMs) in the prostate cancer. Materials and Methods: A broad search of scientific databases including PubMed, EMBASE, Web of Science, Cochrane Database, and Chinese Biomedicine Literature Database (updated prior to November 1st, 2018) was conducted systematically by two reviewers. In this paper, we evaluated the methodological quality of each included article independently and performed a systematic review and meta-analysis to reveal the summary of the diagnostic performance of 68 Ga-PSMA PET and MRI in properly identifying LNMs of intermediate-and/or high-risk prostate cancer. Results: Thirteen eligible articles comprising 1,597 patients were included. For LNMs detection, the pooled sensitivity and specificity of 68 Ga-PSMA PET were 0.65 (95% confidence interval [CI]: 0.49-0.79) and 0.94 (95% CI: 0.88-0.97), respectively, while the corresponding values of MRI were 0.41 (95% CI: 0.26-0.57) and 0.92 (95% CI: 0.86-0.95). The area under the symmetric receiver-operating characteristic (SROC) curve for 68 Ga-PSMA PET and MRI were 0.92 and 0.83, respectively. Conclusions: In intermediate-or high-risk pre-treatment prostate cancer, 68 Ga-PSMA PET had a higher sensitivity and a slightly different specificity in probing the LNMs when comparing with MRI. Moreover, the area under the SROC curve indicated that 68 Ga-PSMA PET was a more effective weapon for predicting the LNMs prior to radical surgery.

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

“…PSMA PET has shown encouraging diagnostic properties in prostate cancer since the first clinical trial was published with Ga-68-PSMA-11 in 2012 [34]. Since then, the use of PSMA PET has been evaluated in numerous settings, including primary staging and biochemical recurrence, as shown in recent systematic reviews [8][9][10][11][12][13]. However, these recent systematic reviews only present a fraction of the knowledge of PSMA PET for primary lymph node staging.…”

“…A final search on August 16 also showed 123 references. The validity of the PubMed search string was verified by the identification of all references presented in the latest systematic reviews of 68Ga-PSMA PET/CT for primary staging with pathology as the reference [8][9][10][11]13]. All references were imported into EndNote X8 (Clarivate Analytics, Philadelphia, US) and were evaluated for inclusion in the review.…”

“…Also, some reports have shown encouraging data with PSMA PET/CT for the detection of lymph node metastases for primary staging. A notable number of systematic reviews have been published on this topic since 2018 [8][9][10][11][12][13]. These systematic reviews comprise a limited number (five to eight) original reports with primary staging with pathology as reference.…”

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

“…Accurate assessment of local tumour stage (T-stage), regional lymph-node involvement (N-stage) and screening for distant metastases (M-stage) is essential, since it significantly affects patient follow-up, therapeutic decisions and oncological outcome [3]. Conventional imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) have moderate sensitivity for the detection of lymph-node metastases (42% and 39%, respectively) [4][5][6]. Therefore, extended pelvic lymph-node dissection (ePLND) remains the preferred technique for nodal staging.…”

Radiolabelled PSMA PET/CT or PET/MRI in hepatocellular carcinoma (HCC): a systematic review

“…Radiolabelled Gallium-68 ( 68 Ga) or Fluorine-18 ( 18 F) prostate-specific membrane antigen (PSMA)-based positron emission tomography/ computed tomography or magnetic resonance imaging (PET/ CT or PET/MRI) are imaging techniques normally used for the evaluation and the diagnosis of prostate cancer (PCa) lesions. PSMA-based imaging is usually performed for the initial staging of intermediate to high risk PCa; restaging after biochemical disease relapse (rising prostate-specific antigen levels) in patients with prior radical prostatectomy or radical external beam radiation are also important field of application [6][7][8].…”