SIU 2017: GA-PSMA-PET/CT VS. Choline-PET/CT in Malignant Prostate Cancer - A Systematic Review

Lisbon, Portugal ( The role of Prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) has increasingly become more prominent in helping diagnose recurrent prostate cancer and advanced prostate cancer. The role of PSMA as a radio tracer appears to be surpassing that of choline tracers in prominent centers. The authors report a comparison, based on current data, between the use of PSMA-PET/CT scans and Choline PET/CT scans.

The authors performed a review of PubMed/Medline, Clinical and the Cochrane Library in March 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement.

Overall, 4 studies were included in this review having directly compared 68GA-PSMA-PET/CT and Choline PET/CT scans. Choline tracers used were 11C in one study and 18F in the other studies. Overall 230 men had both 68GA-PSMA PET and choline-PET/ CT scans. The detection rates for biochemical recurrence were 81.1% for GA-PSMA-PET and 70.3% for choline-PET/CT. This indicates that GA-PSMA PET/CT is significantly better than choline-PET/CT for detecting recurrence of prostate cancer (P<0.005). 68GA-PSMA-PET/CT also showed higher detection rates at lower PSA values. Lesions missed on PSMA-PET/CT but captured by choline-PET/CT were found to be negligible (1-2%).

Generally, it can be said that 68GA-PSMA-PET/CT appears to offer better diagnostic capability than choline-PET/CT, as well as similar if not higher sensitivity and specificity. In concordance with similar recommendations, this increases the justification to replace choline as the radio tracer of choice in prostate cancer. Further research with larger systematic reviews are needed to assess the overall performance of PSMA-PET/CT to confirm and validate its role as the diagnostic tool of choice for detecting prostate cancer recurrence and metastasis.

Presented by: Moghul M
Affiliation: North Middlesex Hospital, London, United Kingdom

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal

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