scholarly journals Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of prostate cancer: a systematic review and meta-analysis

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sungmin Woo ◽  
Soleen Ghafoor ◽  
Anton S. Becker ◽  
Sangwon Han ◽  
Andreas G. Wibmer ◽  
...  
Keyword(s):  
Threshold Effect ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Regression Analyses ◽  
Local Tumor ◽  
Positron Emission ◽  
Psma Pet ◽  
Pet Ct ◽  
Meta Regression ◽  
Specific Membrane

Abstract Purpose Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE). Methods Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect. Results Twelve studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95% CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95% CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95% CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95% CI 0.84-0.97] vs. 0.96 [95% CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, −0.234-0.908] between sensitivity and false-positive rate). Conclusion PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.

scholarly journals Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sungmin Woo ◽  
Soleen Ghafoor ◽  
Anton S. Becker ◽  
Sangwon Han ◽  
Andreas Wibmer ◽  
...  
Keyword(s):  
Threshold Effect ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Regression Analyses ◽  
Local Tumor ◽  
Positron Emission ◽  
Psma Pet ◽  
Pet Ct ◽  
Meta Regression ◽  
Specific Membrane

Abstract Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).Methods: Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.Results: 12 studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95%CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95%CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95%CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95%CI 0.84-0.97] vs. 0.96 [95%CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, -0.234-0.908] between sensitivity and false-positive rate).Conclusion: PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.[S1] [S1]R1-1

scholarly journals Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of Prostate Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sungmin Woo ◽  
Soleen Ghafoor ◽  
Anton S. Becker ◽  
Sangwon Han ◽  
Andreas Wibmer ◽  
...  
Keyword(s):  
Threshold Effect ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Regression Analyses ◽  
Local Tumor ◽  
Positron Emission ◽  
Psma Pet ◽  
Pet Ct ◽  
Meta Regression ◽  
Specific Membrane

Abstract Purpose: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).Methods: Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.Results: 12 studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95%CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95%CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95%CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95%CI 0.84-0.97] vs. 0.96 [95%CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, -0.234-0.908] between sensitivity and false-positive rate).Conclusion: PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI shows significantly greater sensitivity than PET/CT for assessing SVI.

scholarly journals Salvage lymph node dissection for prostate-specific membrane antigen (PSMA) positron emission tomography (PET)-identified oligometastatic disease

2021 ◽  
Vol 15 (10) ◽  
Author(s):  
Adam Bobrowski ◽  
Ur Metser ◽  
Antonio Finelli ◽  
Neil Fleshner ◽  
Alejandro Berlin ◽  
...  
Keyword(s):  
Salvage Surgery ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Node Dissection ◽  
Oligometastatic Disease ◽  
Positron Emission ◽  
Psma Pet ◽  
Pet Ct ◽  
Prospective Trials ◽  
Specific Membrane

Introduction: The availability of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) imaging, particularly in the setting of rising prostate-specific antigen (PSA) after definitive treatment, has led to oligometastatic prostate cancer being increasingly identified. Despite the enthusiasm surrounding treating oligometastatic disease, it has been relatively understudied. We sought to review our salvage lymphadenectomy experience in the PSMA PET/CT era. Methods: We retrospectively reviewed patients undergoing lymphadenectomy following curative intent primary therapy with rising PSA who had undergone a PSMA PET/CT identifying oligometastatic disease (defined as 5 PSMA-avid lesions) between January 2016 to April 2020. The primary endpoint was complete response, defined as achieving a PSA <0.2 ng/ml without concomitant androgen deprivation therapy (ADT). Results: Twenty-two patients were included. Primary curative therapy included radical prostatectomy (86.4%) and brachytherapy (13.6%). Median PSA at salvage surgery was 1.72 ng/ml. Pelvic lymph node dissection was the most performed procedure (72.7%). Median node yield was 10.5, with a median of 1.5 positive nodes on pathology. Eight patients (36.4%) achieved PSA <0.2, with six (27.3%) remaining with PSA <0.2 after a median followup of 23.1 months. Nine (40.9%) had an initial PSA decline, but nadired ≥0.2, and in five (22.7%) the PSA rose immediately after surgery. Overall, ADT was commenced in seven patients (31.8%) at a median of 10.1 months post-salvage surgery. Conclusions: In our series of salvage dissection for PSMA-PET-detected nodal oligometastases, approximately a third achieved PSA <0.2; yet, it was only durable in 27%. Prospective trials of salvage nodal radiation are ongoing; however, more prospective trials of salvage node dissection are needed.

scholarly journals 18F-PSMA-1007 PET in Biochemical Recurrent Prostate Cancer: An Updated Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Matteo Ferrari ◽  
Giorgio Treglia
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Targeted Agents ◽  
Recurrent Prostate Cancer ◽  
Positron Emission ◽  
Pet Ct ◽  
Specific Membrane

Background. Prostate-specific membrane antigen- (PSMA-) targeted agents labeled with fluorine-18 (18F) have recently become available to evaluate patients with biochemical recurrent prostate cancer (BRPCa) by using positron emission tomography/computed tomography (PET/CT) or positron emission tomography/magnetic resonance imaging (PET/MRI). We performed a systematic review and meta-analysis about the detection rate (DR) of 18F-PSMA-1007 PET/CT or PET/MRI in BRPCa patients. Methods. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published through 17 May 2021 was carried out using the following search algorithm: “PSMA” AND “1007”. Only studies providing data on the DR of 18F-PSMA-1007 PET/CT or PET/MRI in BRPCa were included. A random-effects model was used to calculate the pooled DR on a per scan basis. Results. Fifteen articles (853 patients) were selected and included in the systematic review, and ten were included in the quantitative analysis. Most of the studies reported a good DR of 18F-PSMA-1007 PET/CT or PET/MRI in BRPCa including also patients with low prostate-specific membrane antigen (PSA) values. The DR of 18F-PSMA-1007 PET/CT or PET/MRI was dependent on PSA serum values. The pooled DR was 81.3% (95% confidence interval: 74.6–88%) with statistical heterogeneity. A significant reporting bias (publication bias) was not detected. Conclusions. 18F-PSMA-1007 PET/CT or PET/MRI showed a good DR in BRPCa patients in line with other PSMA-targeted agents. The DR of 18F-PSMA-1007 PET/CT or PET/MRI is influenced by serum PSA values. These findings should be confirmed by prospective multicentric trials.

scholarly journals Prostate-specific membrane antigen positron emission tomography compared to multiparametric MRI for prostate cancer diagnosis: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052277
Author(s):  
Yi Zhao ◽  
Naomi Morka ◽  
Benjamin Scott S Simpson ◽  
Alex Freeman ◽  
Alex Kirkham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Positron Emission Tomography ◽  
Meta Analysis ◽  
Multiparametric Mri ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Positron Emission ◽  
Psma Pet ◽  
Specific Membrane

IntroductionThe introduction of multiparametric MRI (mpMRI) has improved almost every aspect of the prostate cancer diagnostic pathway. However, the novel imaging technique, prostate-specific membrane antigen positron emission tomography (PSMA PET) may have demonstrable accuracy in detecting and staging prostate cancer. Here, we describe a protocol for a systematic review and meta-analysis comparing mpMRI to PSMA PET for the diagnosis of suspected prostate cancer.Methods and analysisA systematic search of MEDLINE, EMBASE, PubMed and Cochrane databases will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for screening, data extraction, statistical analysis and reporting. Included papers will be full-text articles providing original data, written in English articles and comparing the use of PSMA PET with mpMRI in the diagnosis of prostate cancer. All studies published between July 1977 and March 2021 will be eligible for inclusion. Study bias and quality will be assessed using Quadas-2 score. To ensure the quality of the reporting of studies, this protocol is written following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.Ethics and disseminationEthical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.PROSPERO registration numberCRD42021239296.

scholarly journals Canadian Urological Association best practice report: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and PET/magnetic resonance (MR) in prostate cancer

2021 ◽  
Vol 15 (6) ◽  
Author(s):  
Bobby Shaygan ◽  
Katherine Zukotynski ◽  
François Bénard ◽  
Cynthia Ménard ◽  
Golmehr Sistani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Positron Emission Tomography ◽  
Best Practice ◽  
Emission Tomography ◽  
Primary Therapy ◽  
Prostate Specific Membrane Antigen ◽  
Positron Emission ◽  
Psma Pet ◽  
Disease Staging ◽  
Specific Membrane

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) is increasingly being used worldwide as part of the clinical workup for men with prostate cancer. With high overall accuracy for the detection of prostate cancer, PSMA-targeted PET has an increasingly established role in the setting of biochemical failure after primary therapy and an evolving role in the setting of initial disease staging; its utility for guiding management in the setting of metastatic disease is less clear. Although the specificity is high, familiarization with potential pitfalls in the interpretation of PSMA-targeted PET, including knowledge of the causes for false positive and negative examinations, is critical. The aim of this article is to provide an illustrative discussion of the current and evolving clinical indications for PSMA-targeted PET, as well as a review of physiologic radiopharmaceutical biodistribution and potential imaging pitfalls.

Considerations on Integrating Prostate-Specific Membrane Antigen Positron Emission Tomography Imaging Into Clinical Prostate Cancer Trials by National Clinical Trials Network Cooperative Groups

2022 ◽  
Author(s):  
Heiko Schöder ◽  
Thomas A. Hope ◽  
Michael Knopp ◽  
William K. Kelly ◽  
Jeff M. Michalski ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Working Group ◽  
Steering Committee ◽  
Emission Tomography ◽  
Prostate Specific Membrane Antigen ◽  
Consensus Document ◽  
Positron Emission ◽  
Clinical Scenarios ◽  
Psma Pet ◽  
Specific Membrane

PURPOSE As prostate-specific membrane antigen (PSMA) positron emission tomography (PET) becomes increasingly available in the United States, the greater sensitivity of the technology in comparison to conventional imaging poses challenges for clinical trials. The NCI Clinical Imaging Steering Committee (CISC) PSMA PET Working Group was convened to coordinate the identification of these challenges in various clinical scenarios and to develop consensus recommendations on how best to integrate PSMA PET into ongoing and upcoming National Clinical Trials Network (NCTN) trials. METHODS NCI CISC and NCI Genitourinary Steering Committee members and leadership nominated clinicians, biostatisticians, patient advocates, and other imaging experts for inclusion in the PSMA PET Working Group. From April to July 2021, the working group met independently and in conjunction with the CISC to frame challenges, including stage migration, response assessment, trial logistics, and statistical challenges, and to discuss proposed solutions. An anonymous, open-ended survey was distributed to members to collect feedback on challenges faced. Representatives from each NCTN group were invited to present an overview of affected trials. From these discussions, the consensus document was developed and circulated for the inclusion of multiple rounds of feedback from both the Working Group and CISC. RESULTS The current consensus document outlines the key challenges for clinical prostate cancer trials resulting from the increasing availability of PSMA PET. We discuss implications for patient selection and definition of end points and provide guidance and potential solutions for different clinical scenarios, particularly with regard to best practices in defining eligibility criteria and outcome measures. RECOMMENDATIONS This article provides guidance regarding clinical trial design and conduct, and the interpretation of trial results.

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