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The diagnostic accuracy of radiolabeled PSMA-ligand PET for tumour staging in newly diagnosed prostate cancer patients compared to histopathology: a systematic review and meta-analysis

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Abstract

Purpose

The current clinical recommendations posit the deployment of specific approved radiolabeled prostate-specific membrane antigen-ligand positron emission tomography (PSMA PET) for detecting metastatic prostate cancer during primary staging. Nevertheless, the precise efficacy of such ligands in localizing intraprostatic tumours (index tumour) and T-staging is not well established. Consequently, the objective of this inquiry is to ascertain the diagnostic accuracy of PSMA-PET in the tumour staging of newly diagnosed prostate cancer by means of a meta-analysis that integrates studies utilizing histological confirmation as the reference standard.

Methods

In this study, we conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases using a predefined collection of search terms. These terms included ‘PSMA PET’, ‘primary staging’, and ‘prostate cancer’. Subsequently, two independent reviewers evaluated all the studies based on predetermined inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Any disparities were resolved by a third reviewer. A random effects Sidik-Jonkman model was applied to conduct a meta-analysis and estimate the diagnostic accuracy on a per-patient basis, along with 95% confidence intervals. Moreover, an appraisal regarding the likelihood of publication bias and the impact of small-study effects was performed utilizing both Egger’s test and a graphical examination of the funnel plot.

Results

The present analysis comprised a total of twenty-three scientific papers encompassing 969 patients and involved their analysis by both qualitative and quantitative approaches. The results of this study demonstrated that the estimated diagnostic accuracy of PSMA PET/CT and PSMA PET/MRI, for the detection of intraprostatic tumours, regardless of the type of PSMA-ligand, was 86% (95% CI: 76–96%) and 97% (95% CI: 94–100%), respectively. Furthermore, the diagnostic accuracy for the detection of extraprostatic extension (EPE) was 73% (95% CI: 64–82%) and 77% (95% CI: 69–85%), while the diagnostic accuracy for the detection of seminal vesicle involvement (SVI) was 87% (95% CI: 80–93) and 90% (95% CI: 82–99%), respectively.

Conclusion

The present investigation has demonstrated that PSMA PET/MRI surpasses currently recommended multiparametric magnetic resonance imaging (mpMRI) in terms of diagnostic accuracy as inferred from a notable data trajectory, whereas PSMA-PET/CT exhibited comparable diagnostic accuracy for intraprostatic tumour detection and T-staging compared to mpMRI. Nevertheless, the analysis has identified certain potential limitations, such as small-study effects and a potential for publication bias, which may impact the overall conclusions drawn from this study.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark

    Farid Gossili, Anna Winther Mogensen & Helle D. Zacho

  2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Farid Gossili, Anna Winther Mogensen & Helle D. Zacho

  3. Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark

    Tea Caroline Konnerup

  4. Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark

    Kirsten Bouchelouche

  5. Department of Nuclear Medicine. Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Ian Alberts & Ali Afshar-Oromieh

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Contributions

The conceptualization of the study was carried out by Helle D Zacho and Farid Gossili, while the methodology was developed by Farid Gossili with support from Kirsten Bouchelouche, Ian Leigh Alberts, Ali Afshar-Oromieh, and Helle D Zacho. Farid Gossili and Anna Winther Mogensen conducted the data extraction, and Tea Caroline Konnerup and Farid Gossili performed the data analysis. The initial draft of the manuscript was prepared by Farid Gossili, and Anna Winther Mogensen, Kirsten Bouchelouche, Ian Leigh Alberts, Ali Afshar-Oromieh, and Helle D Zacho contributed to the review and editing of the manuscript. All authors read and approved the final manuscript.

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Gossili, F., Mogensen, A.W., Konnerup, T.C. et al. The diagnostic accuracy of radiolabeled PSMA-ligand PET for tumour staging in newly diagnosed prostate cancer patients compared to histopathology: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 51, 281–294 (2023). https://doi.org/10.1007/s00259-023-06392-0

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