To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of pretreatment prostate cancer (PCa).
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.
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).
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.
• 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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Area under the curve
Clinically significant prostate cancer
Diagnostic odds ratio
Lymph node metastasis
Multiparametric magnetic resonance imaging
Magnetic resonance imaging
Negative likelihood ratio
Positron emission tomography
Positive likelihood ratio
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Prostate-specific membrane antigen
Summary receiver operating characteristic
Seminal vesicle infiltration
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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.
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.).
The scientific guarantor of this publication is Shancheng Ren.
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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.
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One of the authors (Xiaofei Ye) has significant statistical expertise.
Written informed consent was not required for this study because this study belongs to meta-analysis; the data are from various published literatures.
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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