The Role of PSMA PET/CT and PET/MRI in the Initial Staging of Prostate Cancer

BackgroundDiagnosing the biochemical recurrence (BCR) of prostate cancer (PCa) is a clinical challenge, and early detection of BCR can help patients receive optimal treatment. We conducted a meta-analysis to define the diagnostic accuracy of PET/CT using 18F-labeled choline, fluciclovine, and prostate-specific membrane antigen (PSMA) in patients with BCR.MethodsMultiple databases were searched until March 30, 2021. We included studies investigating the diagnostic accuracy of 18F-choline, 18F-fluciclovine, and 18F-PSMA PET/CT in patients with BCR. The pooled sensitivity, specificity, and detection rate of 18F-labeled tracers were calculated with a random-effects model.ResultsA total of 46 studies met the included criteria; 17, 16, and 13 studies focused on 18F-choline, fluciclovine, and PSMA, respectively. The pooled sensitivities of 18F-choline and 18F-fluciclovine were 0.93 (95% CI, 0.85–0.98) and 0.80 (95% CI, 0.65–0.897), and the specificities were 0.91 (95% CI, 0.73–0.97) and 0.66 (95% CI, 0.50–0.79), respectively. The pooled detection rates of 18F-labeled choline, fluciclovine and PSMA were 66, 74, and 83%, respectively. Moreover, the detection rates of 18F-labeled choline, fluciclovine, and PSMA were 35, 23, and 58% for a PSA level less than 0.5 ng/ml; 41, 46, and 75% for a PSA level of 0.5–0.99 ng/ml; 62, 57, and 86% for a PSA level of 1.0–1.99 ng/ml; 80, 92, and 94% for a PSA level more than 2.0 ng/ml.ConclusionThese three 18F-labeled tracers are promising for detecting BCR in prostate cancer patients, with 18F-choline showing superior diagnostic accuracy. In addition, the much higher detection rates of 18F-PSMA showed its superiority over other tracers, particularly in low PSA levels.Systematic Review RegistrationPROSPERO, identifier CRD42020212531.

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68Ga-PSMA PET/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli?

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2018.07.009 ◽

2018 ◽

Vol 16 (5) ◽

pp. 392-401 ◽

Cited By ~ 21

Author(s):

Thabo Lengana ◽

Ismaheel O. Lawal ◽

Tebatso G. Boshomane ◽

Gbenga O. Popoola ◽

Kgomotso M.G. Mokoala ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Scan ◽

Skeletal Metastasis ◽

Psma Pet ◽

Pet Ct ◽

Fait Accompli ◽

Initial Staging

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PSMA PET/CT in primary prostate cancer diagnostics: an overview of the literature

Tijdschrift voor Urologie ◽

10.1007/s13629-020-00297-5 ◽

2020 ◽

Vol 10 (6-7) ◽

pp. 101-108 ◽

Cited By ~ 2

Author(s):

Esmée C. A. van der Sar ◽

Ludwike M. van Kalmthout ◽

M. G. E. H. Lam

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Sensitivity And Specificity ◽

Current Knowledge ◽

High Specificity ◽

Cancer Diagnostics ◽

Conventional Imaging ◽

Psma Pet ◽

Pet Ct ◽

Initial Staging

Abstract Imaging with radiotracers targeting the prostate-specific membrane antigen (PSMA) receptor is identified as a promising novel technique in prostate cancer (PCa) detection. In this paper we aim to summarize the current knowledge derived from the literature as well as the authors’ experiences on PSMA PET/CT in initial staging of PCa. PSMA PET/CT lesion- and template-based sensitivity and specificity respectively ranged from 35.1–96.1% and 96–100%. Patient-based sensitivity and specificity respectively ranged from 33.3–100% and 95–100%. Accuracy was 92% (95% CI 88–95) versus 65% (95% CI 60–69) compared to conventional imaging (CT and skeletal scintigraphy). PSMA PET/CT is superior for detection of metastases in primary PCa compared to conventional imaging. Also, PSMA PET/CT has a high specificity and moderate sensitivity for lymph node detection in primary PCa. For adequate initial staging, extended pelvic lymph node dissection (ePLND) will still be required, however, PSMA PET/CT can induce important management changes.

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Prostate-specific membrane antigen (PSMA) PET-CT imaging in the investigation and management of biochemical recurrence in prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.208 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 208-208 ◽

Cited By ~ 1

Author(s):

Fergus Keane ◽

Yasser Ged ◽

Megan Greally ◽

Michael A. Maher ◽

Kieran O'Malley ◽

...

Keyword(s):

Prostate Cancer ◽

Metastatic Disease ◽

Biochemical Recurrence ◽

Systemic Disease ◽

Ct Imaging ◽

Prostate Specific Membrane Antigen ◽

Psma Pet ◽

Pet Ct ◽

Specific Membrane

208 Background: It is estimated that within ten years of primary treatment for prostate cancer up to 40% of patients post radical prostatectomy, and up to 50% of patients post radiotherapy will develop disease recurrence. While monitoring of PSA levels is informative of biochemical recurrence, it may precede radiologically detectable recurrence by months to years, and cannot differentiate local/regional recurrence from systemic disease. This represents a management dilemma for treating physicians. The incorporation of PET probes targeting prostate-specific membrane antigen (PSMA) for prostate cancer shows promise for improving the management of patients with prostate cancer, when used alongside existing imaging techniques, like CT, MRI and bone scans. Methods: Retrospective review of all patients referred from our institution for PSMA imaging was carried out. Baseline clinical features were determined and we analyzed impact of PSMA imaging on management outcomes and survival data. Results: 33 patients referred for 68Ga-PSMA-PET imaging were identified. Median age at diagnosis was 65 years (51 -75). The indication for referral in all patients was biochemical recurrence in the absence of radiological evidence of disease by CT imaging and bone scan. Median PSA at time of referral for PSMA scan was 7.3ug/L (1.4ug/L to 87.7ug/L). 100% of patients (n = 33) were upstaged following PSMA imaging, and 30% (n = 10) had more than one site of metastatic disease identified. Most common sites of metastasis were lymph node and bone. Median number of sites of metastatic disease identified by PSMA imaging was one. These results led to a change in management for 96% patients (n = 32). All patients at the time of this review are alive with a median follow up of 13 months, and median progression-free survival of 11 months. Conclusions: PSMA PET-CT directly led to an alteration in the treatment of the majority of patients in this study. This real world data reflects the growing role of PSMA imaging in influencing clinical decisions for prostate cancer patients with biochemical recurrence. Prospective data from randomized studies are awaited to further validate the role of PSMA PET-CT in this patient cohort.

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