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Mari A, Cadenar A, Giudici S, Cianchi G, Albisinni S, Autorino R, Di Maida F, Gandaglia G, Mir MC, Valerio M, Marra G, Zattoni F, Bianchi L, Lombardo R, Shariat SF, Roupret M, Bauckneht M, Vaggelli L, De Nunzio C, Minervini A. A systematic review and meta-analysis to evaluate the diagnostic accuracy of PSMA PET/CT in the initial staging of prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00850-y. [PMID: 38822051 DOI: 10.1038/s41391-024-00850-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/04/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Positron Emission Tomography-Computed Tomography using Prostate-Specific Membrane Antigen (PSMA PET/CT) is notable for its superior sensitivity and specificity in detecting recurrent PCa and is under investigation for its potential in pre-treatment staging. Despite its established efficacy in nodal and metastasis staging in trial setting, its role in primary staging awaits fuller validation due to limited evidence on oncologic outcomes. This systematic review and meta-analysis aims to appraise the diagnostic accuracy of PSMA PET/CT compared to CI for comprehensive PCa staging. METHODS Medline, Scopus and Web of science databases were searched till March 2023. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Primary outcomes were specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of PSMA PET/CT for local, nodal and metastatic staging in PCa patients. Due to the unavailability of data, a meta-analysis was feasible only for detection of seminal vesicles invasion (SVI) and LNI. RESULTS A total of 49 studies, comprising 3876 patients, were included. Of these, 6 investigated accuracy of PSMA PET/CT in detection of SVI. Pooled sensitivity, specificity, PPV and NPV were 42.29% (95%CI: 29.85-55.78%), 87.59% (95%CI: 77.10%-93.67%), 93.39% (95%CI: 74.95%-98.52%) and 86.60% (95%CI: 58.83%-96.69%), respectively. Heterogeneity analysis revealed significant variability for PPV and NPV. 18 studies investigated PSMA PET/CT accuracy in detection of LNI. Aggregate sensitivity, specificity, PPV and NPV were 43.63% (95%CI: 34.19-53.56%), 85.55% (95%CI: 75.95%-91.74%), 67.47% (95%CI: 52.42%-79.6%) and 83.61% (95%CI: 79.19%-87.24%). No significant heterogeneity was found between studies. CONCLUSIONS The present systematic review and meta-analysis highlights PSMA PET-CT effectiveness in detecting SVI and its good accuracy in LNI compared to CI. Nonetheless, it also reveals a lack of high-quality research on its performance in clinical T staging, extraprostatic extension and distant metastasis evaluation, emphasizing the need for further rigorous studies.
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Affiliation(s)
- Andrea Mari
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy.
| | - Anna Cadenar
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy
| | - Sofia Giudici
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy
| | - Gemma Cianchi
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy
| | - Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Fabrizio Di Maida
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - M Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Massimo Valerio
- Department of Urology, University Hospital of Geneva, Geneva, Switzerland
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, 10065, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- European Association of Urology Research Foundation, Arnhem, The Netherlands
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien
| | - Morgan Roupret
- Urology, Predictive Onco-Urology, AP-HP, Urology Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Vaggelli
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Minervini
- Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy
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Yadav D, Hwang H, Qiao W, Upadhyay R, Chapin BF, Tang C, Aparicio A, Lopez-Olivo MA, Kang SK, Macapinlac HA, Bathala TK, Surasi DS. 18F-Fluciclovine versus PSMA PET Imaging in Primary Tumor Detection during Initial Staging of High-Risk Prostate Cancer: A Systematic Review and Meta-Analysis. Radiol Imaging Cancer 2022; 4:e210091. [PMID: 35212559 PMCID: PMC8965534 DOI: 10.1148/rycan.210091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
Purpose Fluorine 18 (18F)-fluciclovine and prostate-specific membrane antigen (PSMA) tracers are commonly used for localizing biochemical recurrence of prostate cancer, but their accuracy in primary tumor detection in the initial staging of high-risk prostate cancer has not been established. Materials and Methods A systematic review was performed of the electronic databases for original studies published between 2012 and 2020. Included studies were those in which 18F-fluciclovine or PSMA PET was used for initial staging of patients with high-risk prostate cancer. The diagnostic performance data were collected for primary tumor with histopathologic results as reference standard. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used for quality appraisal. A random-effects model was used to summarize the effect sizes and to evaluate the difference between two groups. Results Overall, 28 studies met the eligibility criteria, and 17 were included in the meta-analysis (18F-fluciclovine = 4, PSMA = 13). Of these 17 studies, 12 (70%) were judged to have high risk of bias in one of the evaluated domains, and nine studies were deemed to have applicability concerns. The pooled sensitivity, specificity, and diagnostic odds ratio for 18F-fluciclovine versus PSMA were 85% (95% CI: 73%, 92%) versus 84% (95% CI: 77%, 89%) (P = .78), 77% (95% CI: 60%, 88%) versus 83% (95% CI: 76%, 89%) (P = .40), and 18.88 (95% CI: 5.01, 71.20) versus 29.37 (95% CI: 13.35, 64.60) (P = .57), respectively, with no significant difference in diagnostic test accuracy. Conclusion 18F-fluciclovine and PSMA PET demonstrated no statistically significant difference in diagnostic accuracy in primary tumor detection during initial staging of high-risk prostate cancer. Keywords: PET, Prostate, Molecular Imaging-Cancer, Staging Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Divya Yadav
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Hyunsoo Hwang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Wei Qiao
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Rituraj Upadhyay
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Brian F. Chapin
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Chad Tang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Ana Aparicio
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Maria A. Lopez-Olivo
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Stella K. Kang
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Homer A. Macapinlac
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Tharakeswara K. Bathala
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
| | - Devaki Shilpa Surasi
- From the Departments of Radiation Oncology (D.Y., R.U., C.T.),
Biostatistics (H.H., W.Q.), Urology (B.F.C.), Genitourinary Medical Oncology
(A.A.), Health Services Research (M.A.L.O.), Nuclear Medicine (H.A.M., D.S.S.),
and Abdominal Imaging (T.K.B.), The University of Texas MD Anderson Cancer
Center, 1515 Holcombe Blvd, Unit 483, Houston, TX 77030; and Department of
Radiology, NYU Langone Health, New York, NY (S.K.K.)
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Hernes E, Revheim ME, Hole KH, Tulipan AJ, Strømme H, Lilleby W, Seierstad T. Prostate-Specific Membrane Antigen PET for Assessment of Primary and Recurrent Prostate Cancer with Histopathology as Reference Standard: A Systematic Review and Meta-Analysis. PET Clin 2021; 16:147-165. [PMID: 33648661 DOI: 10.1016/j.cpet.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prostate-specific membrane antigen PET is a promising diagnostic tool in prostate cancer. The gold standard for the detection of prostate tumor and lymph node metastases is histopathology. The aim of the present review was to investigate accuracy measures of 68Ga/18F-labeled prostate-specific membrane antigen PET tracers in primary and recurrent prostate cancer with systematic sector-based histopathology as the reference standard. A systematic literature search was performed and 34 studies were included. Overall, prostate-specific membrane antigen PET showed high specificity, but variable sensitivity to localize known prostate cancer and detect pelvic lymph node metastases.
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Affiliation(s)
- Eivor Hernes
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Knut Håkon Hole
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Andreas Julius Tulipan
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Wolfgang Lilleby
- Department of Oncology, Oslo University Hospital, P.O. Box 4953 Nydalen, 0424 Oslo, Norway
| | - Therese Seierstad
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
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