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Head-to-head comparison of prostate-specific membrane antigen PET and multiparametric MRI in the diagnosis of pretreatment patients with prostate cancer: a meta-analysis

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Abstract

Objectives

To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of pretreatment prostate cancer (PCa).

Methods

Pubmed, Embase, Medline, Web of Science, and Cochrane Library were searched for eligible studies published before June 22, 2022. We assessed risk of bias and applicability by using QUADAS-2 tool. Data synthesis was performed with Stata 17.0 software, using the “midas” and “meqrlogit” packages.

Results

We included 29 articles focusing on primary cancer detection, 18 articles about primary staging, and two articles containing them both. For PSMA PET versus mpMRI in primary PCa detection, sensitivities and specificities in the per-patient analysis were 0.90 and 0.84 (p<0.0001), and 0.66 and 0.60 (p <0.0001), and in the per-lesion analysis they were 0.79 and 0.78 (p <0.0001), and 0.84 and 0.82 (p <0.0001). For the per-patient analysis of PSMA PET versus mpMRI in primary staging, sensitivities and specificities in extracapsular extension detection were 0.59 and 0.66 (p =0.005), and 0.79 and 0.76 (p =0.0074), and in seminal vesicle infiltration (SVI) detection they were 0.51 and 0.60 (p =0.0008), and 0.93 and 0.96 (p =0.0092). For PSMA PET versus mpMRI in lymph node metastasis (LNM) detection, sensitivities and specificities in the per-patient analysis were 0.68 and 0.46 (p <0.0001), and 0.91 and 0.90 (p =0.81), and in the per-lesion analysis they were 0.67 and 0.36 (p <0.0001), and 0.99 and 0.99 (p =0.18).

Conclusion

PSMA PET has higher diagnostic value than mpMRI in the detection of primary PCa. Regarding the primary staging, mpMRI has potential advantages in SVI detection, while PSMA PET has relative advantages in LNM detection.

Clinical relevance statement

The integration of prostate-specific membrane antigen (PSMA) PET into the diagnostic pathway may be helpful for improving the accuracy of prostate cancer detection. However, further studies are needed to address the cost implications and evaluate its utility in specific patient populations or clinical scenarios. Moreover, we recommend the combination of PSMA PET and mpMRI for cancer staging.

Key Points

• Prostate-specific membrane antigen PET has higher sensitivity and specificity for primary tumor detection in prostate cancer compared to multiparametric MRI.

• Prostate-specific membrane antigen PET also has significantly better sensitivity and specificity for lymph node metastases of prostate cancer compared to multiparametric MRI.

• Multiparametric MRI has better accuracy for extracapsular extension and seminal vesicle infiltration compared to ate-specific membrane antigen PET.

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Abbreviations

AUC:

Area under the curve

csPCa:

Clinically significant prostate cancer

DOR:

Diagnostic odds ratio

ECE:

Extracapsular extension

LNM:

Lymph node metastasis

mpMRI:

Multiparametric magnetic resonance imaging

MRI:

Magnetic resonance imaging

NLR:

Negative likelihood ratio

PCa:

Prostate cancer

PET:

Positron emission tomography

PLR:

Positive likelihood ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PSMA:

Prostate-specific membrane antigen

SROC:

Summary receiver operating characteristic

SVI:

Seminal vesicle infiltration

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Acknowledgements

We thank Professor Jie Xu from the Foreign Language Teaching and Research Office of the International Military Medical Exchange Center of Naval Medical University for her help in this manuscript language and grammar.

Funding

This study has received funding by grants from the National Natural Science Foundation of China (82125025 to S.R.), Shanghai Shenkang Hospital Development Center (SHDC12022117 to S.R., SHDC2022CRT005 to S.R.), and the Education Commission of Shanghai Municipality (S.R.).

Author information

Author notes

  1. Jianglei Ma, Qinqin Yang, Xiaofei Ye, Weidong Xu, and Yifan Chang contributed equally to this study.

Authors and Affiliations

  1. Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China

    Jianglei Ma, Weidong Xu, Ye Wang, Yihaoyun Lou, Duocai Li, Yusi Xu, Wei He, Minglei Cai, Wanli Cao, Guanqun Ju, Lei Yin, Junkai Wang, Jizhong Ren & Shancheng Ren

  2. Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China

    Qinqin Yang & Changjing Zuo

  3. Department of Health Statistics, Naval Medical University, Shanghai, 200433, China

    Xiaofei Ye

  4. Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China

    Yifan Chang & Rui Chen

  5. College of Basic Medical Sciences, Naval Medical University, Shanghai, 200433, China

    Mengting Luo

  6. Department of Urology, Hengyang Central Hospital, Hengyang, 421001, Hu’nan, China

    Xuming Yang & Zifang Ma

Authors
  1. Jianglei Ma
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  2. Qinqin Yang
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  3. Xiaofei Ye
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  4. Weidong Xu
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  5. Yifan Chang
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  6. Rui Chen
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  7. Ye Wang
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  8. Mengting Luo
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  9. Yihaoyun Lou
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  10. Xuming Yang
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  11. Duocai Li
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  12. Yusi Xu
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  13. Wei He
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  14. Minglei Cai
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  15. Wanli Cao
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  16. Guanqun Ju
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  17. Lei Yin
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  18. Junkai Wang
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  19. Jizhong Ren
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  20. Zifang Ma
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  21. Changjing Zuo
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  22. Shancheng Ren
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Corresponding authors

Correspondence to Zifang Ma, Changjing Zuo or Shancheng Ren.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Shancheng Ren.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Xiaofei Ye) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this study belongs to meta-analysis; the data are from various published literatures.

Ethical approval

Institutional Review Board approval was not required because this study belongs to meta-analysis.

Methodology

• retrospective

• meta-analysis

• multicentre study

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Ma, J., Yang, Q., Ye, X. et al. Head-to-head comparison of prostate-specific membrane antigen PET and multiparametric MRI in the diagnosis of pretreatment patients with prostate cancer: a meta-analysis. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10436-2

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  • DOI: https://doi.org/10.1007/s00330-023-10436-2

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