Impact of ⁶⁸Gallium prostate‐specific membrane antigen tracers on the management of patients with prostate cancer who experience biochemical recurrence

Abstract

Objective To investigate the impact of 68Gallium prostate‐specific membrane antigen (68Ga‐PSMA) tracers on the management of prostate cancer (PCa) patients with biochemical recurrence (BCR) by conducting a systematical review and meta‐analysis. Materials and Methods We performed a literature search of the PubMed, Embase and Web of Science databases up to 29 October 2019. We included studies that reported the proportion of patients whose management changed after 68Ga‐PSMA tracers were used in patients with BCR. We used the Quality Assessment of Diagnostic Accuracy Studies‐2 tool to evaluate the quality of the included studies. The proportion of patients with management changes were pooled using a random‐effects model. Subgroup analyses and meta‐regression analyses were performed to explore the source of heterogeneity. A Sankey diagram was used to show treatment change from before to after the use of 68Ga‐PSMA tracers. Results We included 20 eligible studies (2026 patients). The pooled proportion of patients with management change was 53% (95% confidence interval [CI] 46–60) in patients with BCR and 51% (95% CI, 34–67) in patients with early BCR (prostate‐specific antigen [PSA] <0.5 ng/mL). The pooled positron‐emission tomography‐positive rate in patients with BCR was 68% (95% CI 59–78). Fourteen studies reported management change, with most changes being intermodal in nature (42%, vs 17% intramodal change). Conclusions The use of 68Ga‐PSMA tracers altered the management of more than half of PCa patients with BCR, including those with early BCR. 68Ga‐PSMA tracers might be used to guide individualized treatment in patients with BCR, particularly those with early BCR.

18F-PSMA-1007 PET in Biochemical Recurrent Prostate Cancer: An Updated Meta-Analysis

“…Interestingly, a significant percentage of change of management was reported in these studies ranging from 64 to 79% of cases. These findings are in line with those reported using PET with other PSMA-targeted agents in BRPCa [ 42 ].…”

Performance of 18F-DCFPyL PET/CT Imaging in Early Detection of Biochemically Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis

“…Therefore, PSMA radiopharmaceuticals have been increasingly used to detect small tumor lesions, lymph node, bone, or visceral metastases because of its high sensitivity even at low PSA levels. Several PSMA radioligands such as Gallium-68 (68Ga), Fluorine-18 (18F), Lutetium-177 (177Lu), or Copper-64 (64Cu) are currently available to obtain effective radiotherapeutics for theranostic applications (16)(17)(18)(19)(20). 68Ga-PSMA PET/CT Abbreviations: PSMA, prostate-specific membrane antigen; PET/CT, positron emission tomography/computed tomography; BRPCa, biochemically recurrent prostate cancer; CI, confidence interval; DR, detection rate; PSA, prostatespecific antigen; PCa, prostate cancer; BCR, biochemical recurrence; RP, radical prostatectomy; EBRT, external beam radiation therapy; RT, radiation therapy; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; QUADAS-2, quality assessment of diagnostic accuracy studies;…”

The Evolving Role of 18F-FDG PET/CT in Diagnosis and Prognosis Prediction in Progressive Prostate Cancer

“…A retrospective analysis included 294 patients and showed the sensitivity and specificity were both around 70%, and the SUVmax impacted therapeutic management ( 53 ). A meta-analysis showed PSMA-positive rate in patients was 68% and it was correlated with early biochemical recurrence ( 54 ). Several prospective studies report management changes after PSMA with biochemical recurrence of prostate cancer ( 55 , 56 ).…”