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

Abstract

Background: PSMA PET is a promising method for primary lymph node staging in prostate cancer. However, recent systematic reviews have identified only a limited number of studies with histopathology as a reference test. Methods: A systematic search was performed in PubMed and the Cochrane Library. An expedited systematic review was performed where we identified diagnostic studies in prostate cancer where a preoperative PSMA PET for primary lymph node staging was compared to histopathology. The trials must have diagnostic data on a patient level. Results: Eighteen eligible clinical trials included 969 patients. The median patient number per study was 32 (range 10 to 208). Five trials were prospective, and nine trials had a consecutive enrolment of patients. Sixteen studies used Ga-68-PSMA-11; there was one study with Cu-64-PSMA and one study with F-18-DCDFPyL. Twelve studies used PET/CT, four trials used PET/MR. Most trials included patients with intermediate and high-risk. Diagnostic accuracy varied notably among the studies; sensitivity ranged from 23 to 100%, specificity 67-100%, positive predictive value 20-100%, and negative predictive value 41-100%. Weighted sensitivity was 59%, weighted specificity was 93%. Four studies compared PSMA PET with anatomical imaging (CT or MRI); in all cases, sensitivity and specificity were superior with PSMA PET. Three studies compared PSMA PET with multi-parametric or diffusion-weighted MRI with mixed results. Conclusions: PSMA PET showed promising diagnostic accuracy for primary lymph node staging with pathology as reference. Recommendation for PSMA PET for high-risk patients in clinical guidelines should be supported by confirmatory, prospective trials with patient-relevant outcomes.

Modular Medical Imaging Agents Based on Azide–Alkyne Huisgen Cycloadditions: Synthesis and Pre‐Clinical Evaluation of 18F‐Labeled PSMA‐Tracers for Prostate Cancer Imaging

“…In the 90’s, the discovery of the prostate‐specific membrane antigen (PSMA), overexpressed in PCa, improved the clinical assessment of PCa by nuclear medicine imaging . Next to the presence in primary tumors, PSMA is expressed in metastases and primary lymph nodes, as well as in the recurrent disease . Hence, three PSMA‐targeting tracers have been clinically introduced for this purpose: [ 68 Ga]PSMA‐11, [ 18 F]PSMA‐1007 and [ 18 F]DCFPyL .…”

Clinical impact of PSMA PET/CT in primary prostate cancer compared to conventional nodal and distant staging: a retrospective single center study

“…More recently, PSMA PET/CT imaging was evaluated as a potential tool for staging primary prostate cancer in men prior to curative treatment [7]. Specificity rates of 84-100% were reported by earlier studies [8][9][10][11] and in a recent systematic review [12]. However, the sensitivity of PSMA PET/CT for the detection of lymph node metastases is moderate (33-91%), most likely due to the limitations in the spatial resolution to detect small (< 3 mm) lymph node tumour deposits in primary as well as recurrent prostate cancer [13].…”

Focal Unspecific Bone Uptake on [18F]-psma-1007 Pet: A Multicenter Retrospective Evaluation of the Distribution, Frequency, and Quantitative Parameters of a Potential Pitfall in Prostate Cancer Imaging

“…Positron emission tomography (PET), combined with either computer tomography (CT) or magnetic resonance imaging (MRI), utilizing radiotracers that bind to prostate-speci c membrane antigen (PSMA) is an excellent diagnostic tool for prostate cancer imaging. In the past few years, PSMA-PET has evolved to become the leading advanced imaging modality in the Western world, especially for patients with early biochemical recurrence (EBR) [1,2]. In various studies, PSMA-PET/CT has shown better detection e cacy in EBR than MRI, CT, conventional imaging [3][4][5][6], or choline-labeled PET ligands [7].…”