The utility of PET-based imaging for prostate cancer biochemical recurrence: a systematic review and meta-analysis

  • Niranjan J. SathianathenEmail author
  • Mohit Butaney
  • Badrinath R. Konety
Topic Paper



Conventional imaging modalities have been poor in characterizing the true extent of disease in men with biochemical recurrence following primary treatment for prostate cancer. Functional imaging with positron emission tomography (PET) has shown promise of being a superior imaging modality. We conducted a systematic review and meta-analysis to define the diagnostic accuracy of PET/CT using 11C-choline, 18F-FACBC, or 68Ga-PSMA in detecting recurrent prostate cancer.


We searched multiple databases in line with the preferred reporting items for systematic review and meta-analysis (PRISMA) statement to define the diagnostic accuracy of 11C-choline, 18F-FACBC, or 68Ga-PSMA PET/CT. Only studies secondarily staging participants with biochemical recurrence and those with an appropriate reference standard (pathology, further imaging, and/or clinical response) were eligible for analysis.


Twenty-one studies with 3202 participants met the inclusion criteria. Of these, 11C-choline, 18F-FACBC, and 68Ga-PSMA were the tracer investigated in 16, 5, and 1 studies, respectively. The summary sensitivity for each tracer was 80.9% (95% CI 70.4–88.3%), 79.7% (95% CI 51.9–93.4%), and 76.4% (95% CI 68.3–82.9%), respectively. The corresponding summary specificity was 84.1% (95% CI 70.2–92.2%), 61.9% (95% CI 41.1–79.0%), and 99.8% (95% CI 97.5–100%), respectively. Detection rates ranged between 58.6 and 82.8%. All included studies were judged to be at high risk of bias primarily due to study limitations pertaining to the reference standard.


There is a lack of high-quality data to verify the accuracy of PET-based imaging using 11C-choline, 18F-FACBC, or 68Ga-PSMA. The early results are encouraging that these techniques are superior to conventional imaging modalities, which would allow salvage therapies to be optimized.


Cancer staging Positron emission tomography Prostate cancer Systematic review 


Author contributions

NJS: protocol, project development, data collection, data analysis, and manuscript writing. MB: protocol, project development, data collection, and manuscript writing. BRK: protocol, project development, and manuscript writing.


NJS has received support from the Cloverfields Foundation and The Institute for Prostate and Urologic Cancers (University of Minnesota).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

For this type of study, formal consent is not required.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Niranjan J. Sathianathen
    • 1
    Email author
  • Mohit Butaney
    • 1
  • Badrinath R. Konety
    • 1
  1. 1.Department of UrologyUniversity of MinnesotaMinneapolisUSA

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