Diagnostic Performance of Prostate-specific Membrane Antigen Positron Emission Tomography–targeted biopsy for Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis

Context: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has gained acceptance as a staging tool for prostate cancer (PCa). Recent reports suggest an association between PSMA PET and detection of clinically significant PCa (csPCa) on prostate biopsy.

Objective: To assess the diagnostic accuracy of PSMA PET–targeted biopsy (PSMA-PET-TB) for csPCa detection.
Evidence acquisition

We searched PubMed, Web of Science, and Scopus in December 2021 to identify studies assessing the accuracy of PSMA-PET-TB for csPCa detection. A diagnostic meta-analysis was performed to calculate pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PSMA-PET-TB alone and in combination with magnetic resonance imaging (MRI)-TB for detecting csPCa.

Evidence synthesis: Overall, five prospective studies involving 497 patients were eligible for this meta-analysis. For csPCa detection, PSMA-PET-TB had pooled sensitivity, specificity, PPV, and NPV of 0.89 (95% confidence interval [CI] 0.85–0.93), 0.56 (95% CI 0.29–0.80), 0.69 (95% CI 0.58–0.79), and 0.78 (95% CI 0.50–0.93), respectively. Among the three studies assessing the PSMA-PET + MRI-TB strategy, the pooled sensitivity, specificity, PPV, and NPV for csPCa detection were 0.91 (95% CI 0.77–0.97), 0.64 (95% CI 0.40–0.82), 0.75 (95% CI 0.56–0.87), and 0.85 (95% CI 0.62–0.95), respectively. For lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of 3, the sensitivity, specificity, PPV, and NPV were 0.69, 0.73, 0.48, and 0.86, respectively.

Conclusions: PSMA-PET-TB appears to have favorable diagnostic accuracy for csPCa detection and combination with MRI seems to improve this. According to our meta-analysis, PSMA-PET has promising clinical application for detection of csPCa, namely in the case of PI-RADS 3 lesions. Further prospective studies are needed to explore the true clinical utility of a PSMA-PET-based diagnostic pathway.

Patient summary: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is a promising imaging method for detecting clinically significant prostate cancer and seems to have additional value to magnetic resonance imaging (MRI) for detection.

Tatsushi Kawada, Takafumi Yanagisawa, Pawel Rajwa, Reza Sari Motlagh, Hadi Mostafaei, Fahad Quhal, Ekaterina Laukhtina, Abdulmajeed Aydh, Frederik König, Maximilian Pallauf, Benjamin Pradere, Francesco Ceci, Pascal A.T. Baltzer, Marcus Hacker, Sazan Rasul, Pierre I. Karakiewicz, Motoo Araki, Yasutomo Nasu, Shahrokh F. Shariat

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Medical University of Silesia, Zabrze, Poland; Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, King Faisal Medical City, Abha, Saudi Arabia; Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria; Division of Nuclear Medicine, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria; Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Wahringer Gurtel 43 18–20, 1090 Vienna, Austria.

Source: Kawada T., Yanagisawa T., Rajwa P. et al. "Diagnostic Performance of Prostate-specific Membrane Antigen Positron Emission Tomography–targeted biopsy for Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis." European Urology Oncology. 2022. VOLUME 5, ISSUE 4, P390-400.
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