Comparison of Multiparametric MRI and the Combination of PSMA Plus MRI for the Intraprostatic Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis.

The aim of this study was to perform a head-to-head comparison of multiparametric MRI (mpMRI) and the combination of prostate-specific membrane antigen (PSMA) PET plus MRI (PSMA + MRI) for detecting intraprostatic clinically significant prostate cancer (csPCa).

Relevant databases were searched through November 2023. Only studies directly comparing mpMRI and PSMA + MRI (PET/MRI or PET/CT + mpMRI) were included. A meta-analysis with a random-effects model was used to estimate pooled sensitivity, specificity, and area under the curve for each approach.

A total of 19 studies were included. On a patient-level analysis, PSMA + MRI had higher sensitivity (9 studies) than mpMRI for csPCa detection (96% [95% confidence interval (CI): 92%, 98%] vs 89% [95% CI: 81%, 94%]; P = 0.04). The patient-level specificity (4 studies) of PSMA + MRI was 55% (95% CI: 31%-76%) compared with 50% (95% CI: 44%-57%) of mpMRI (P = 0.67). Region-level sensitivity (10 studies) was 85% (95% CI: 74%-92%) for PSMA + MRI and 71% (95% CI: 58%-82%) for mpMRI (P = 0.09), whereas specificity (4 studies) was 87% (95% CI: 76%-94%) and 90% (95% CI: 82%-95%), respectively (P = 0.59). Lesion-level sensitivity and specificity were similar between modalities with pooled data from less than 4 studies.

PSMA + MRI had superior pooled sensitivity and similar specificity for the detection of csPCa compared with mpMRI in this meta-analysis of head-to-head studies.

Clinical nuclear medicine. 2024 May 21 [Epub ahead of print]

Giovanni Brondani Torri, Pedro Antune Pereira, Camila Piovesan Wiethan, Yasmin Mesquita, Seyed Ali Mirshahvalad, Patrick Veit-Haibach, Sangeet Ghai, Ur Metser, Stephan Altmayer, Adriano Basso Dias

From the Department of Radiology and Diagnostic Imaging, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul., University Medical Imaging Toronto, Joint Department of Medical Imaging, University of Toronto., Division of Medicine, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil., Department of Radiology, Stanford University School of Medicine, Stanford, CA.