Comparison of Multiparametric Magnetic Resonance Imaging with Prostate-Specific Membrane Antigen Positron-Emission Tomography Imaging in Primary Prostate Cancer Diagnosis: A Systematic Review and Meta-Analysis.

Multiparametric magnetic-resonance imaging (mpMRI) has proven utility in diagnosing primary prostate cancer. However, the diagnostic potential of prostate-specific membrane antigen positron-emission tomography (PSMA PET) has yet to be established. This study aims to systematically review the current literature comparing the diagnostic performance of mpMRI and PSMA PET imaging to diagnose primary prostate cancer. A systematic literature search was performed up to December 2021. Quality analyses were conducted using the QUADAS-2 tool. The reference standard was whole-mount prostatectomy or prostate biopsy. Statistical analysis involved the pooling of the reported diagnostic performances of each modality, and differences in per-patient and per-lesion analysis were compared using a Fisher's exact test. Ten articles were included in the meta-analysis. At a per-patient level, the pooled values of sensitivity, specificity, and area under the curve (AUC) for mpMRI and PSMA PET/CT were 0.87 (95% CI: 0.83-0.91) vs. 0.93 (95% CI: 0.90-0.96, p < 0.01); 0.47 (95% CI: 0.23-0.71) vs. 0.54 (95% CI: 0.23-0.84, p > 0.05); and 0.84 vs. 0.91, respectively. At a per-lesion level, the pooled sensitivity, specificity, and AUC value for mpMRI and PSMA PET/CT were lower, at 0.63 (95% CI: 0.52-0.74) vs. 0.79 (95% CI: 0.62-0.92, p < 0.001); 0.88 (95% CI: 0.81-0.95) vs. 0.71 (95% CI: 0.47-0.90, p < 0.05); and 0.83 vs. 0.84, respectively. High heterogeneity was observed between studies. PSMA PET/CT may better confirm the presence of prostate cancer than mpMRI. However, both modalities appear comparable in determining the localisation of the lesions.

Cancers. 2022 Jul 19*** epublish ***

Yi Zhao, Benjamin S Simpson, Naomi Morka, Alex Freeman, Alex Kirkham, Daniel Kelly, Hayley C Whitaker, Mark Emberton, Joseph M Norris

School of Medicine, Imperial College London, London SW7 2BX, UK., UCL Cancer Institute, University College London, London WC1E 6BT, UK., UCL Medical School, University College London, London WC1E 6BT, UK., Department of Pathology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK., Department of Radiology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK., School of Healthcare Sciences, Cardiff University, Cardiff CF10 3AT, UK., UCL Division of Surgery & Interventional Science, University College London, London WC1E 6BT, UK.

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