To systematically review currently available data on 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) used for the primary staging of high-risk prostate cancer.
We performed critical reviews of EMBASE, Web of Science (including MEDLINE) and Cochrane databases in October 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We included studies that utilized 68Ga-PSMA PET for primary staging of prostate cancer. Quality was assessed using the Critical Appraisal Skills Programme checklist for diagnostic test studies.
Following our systematic search strategy, 12 studies were included for assessment. These studies comprised a total of 322 patients who underwent 68Ga-PSMA PET scanning for the purpose of primary staging. Only 5 of these studies included histopathologic correlation data. High variation in methodology and outcomes such as sensitivity (range 33–99%) and specificity (> 90%) was seen across all studies. The ability of 68Ga-PSMA PET to detect malignant lesions was evident across studies, with most studies demonstrating increased detection rates with respect to conventional imaging modalities.
In the primary staging of prostate cancer 68Ga-PSMA PET appears to outperform traditional imaging modalities. Overall, there are few high-quality studies investigating 68Ga-PSMA PET in this sub-group highlighting the need for formal assessment of PSMA PET in the form of large-volume, prospective studies.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108
Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71(4):630–642
Mottet NBJ, Briers E, Bolla M, Cornford P, De Santis M, Henry A, Joniau A, Lam T, Mason MD, Matveev V, van der Kwast TH, van der Poel H, Rouvière O, Wiegel T; members of the EAU–ESTRO–SIOG prostate cancer guidelines Panel., EAU–ESTRO–SIOG guidelines on prostate cancer. Edn. Presented at the EAU Annual Congress MI—PEGO. https://uroweb.org/guideline/prostate-cancer/. Accessed 26 Mar 2017
Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395
Chang SS (2004) Overview of prostate-specific membrane antigen. Rev Urol 6(Suppl 10):S13–S18
Huang E, Teh BS, Mody DR, Carpenter LS, Butler EB (2003) Prostate adenocarcinoma presenting with inguinal lymphadenopathy. Urology 61(2):463
Wu LM, Xu JR, Ye YQ, Lu Q, Hu JN (2012) The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: a systematic review and meta-analysis. AJR Am J Roentgenol 199(1):103–110
Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C (1997) Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 3(1):81–85
Sweat SD, Pacelli A, Murphy GP, Bostwick DG (1998) Prostate-specific membrane antigen expression is greatest in prostate adenocarcinoma and lymph node metastases. Urology 52(4):637–640
Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M et al (2015) The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42(2):197–209
Eder M, Schafer M, Bauder-Wust U, Hull WE, Wangler C, Mier W et al (2012) 68 Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 23(4):688–697
Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA et al (2013) PET imaging with a [68 Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 40(4):486–495
Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG et al (2016) Sensitivity, specificity, and predictors of positive 68 Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 70(6):926–937
Critical Appraisal Skills Programme. CASP (Diagnostic Test Study) Checklist 2017 [cited 2017 October 28]. http://www.casp-uk.net/casp-tools-checklists
Budaus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H et al (2016) Initial experience of (68)Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol 69(3):393–396
Demirkol MO, Acar O, Ucar B, Ramazanoglu SR, Saglican Y, Esen T (2015) Prostate-specific membrane antigen-based imaging in prostate cancer: impact on clinical decision making process. Prostate 75(7):748–757
Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C et al (2016) 68 Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer. Eur Urol 70(4):553–557
Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter CO et al (2015) Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68 Ga-PSMA-positron emission tomography/computerized tomography. Prostate 75(16):1934–1940
Kabasakal L, Demirci E, Ocak M, Akyel R, Nematyazar J, Aygun A et al (2015) Evaluation of PSMA PET/CT imaging using a 68 Ga-HBED-CC ligand in patients with prostate cancer and the value of early pelvic imaging. Nucl Med Commun 36(6):582–587
Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G et al (2016) Diagnostic efficacy of (68)Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 195(5):1436–1443
Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ et al (2016) Correlation of intraprostatic tumor extent with (6)(8)Ga-PSMA distribution in patients with prostate cancer. J Nucl Med 57(4):563–567
Sachpekidis C, Kopka K, Eder M, Hadaschik BA, Freitag MT, Pan L et al (2016) 68 Ga-PSMA-11 dynamic PET/CT imaging in primary prostate cancer. Clin Nucl Med 41(11):e473–e479
Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K et al (2017) Comparison of 68 Ga-labelled PSMA-11 and 11C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging 44(1):92–101
Sterzing F, Kratochwil C, Fiedler H, Katayama S, Habl G, Kopka K et al (2016) (68)Ga-PSMA-11 PET/CT: a new technique with high potential for the radiotherapeutic management of prostate cancer patients. Eur J Nucl Med Mol Imaging 43(1):34–41
Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D et al (2017) 68 Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging 44:941–946
van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q et al (2017) Prospective evaluation of 68 gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int 119(2):209–215
We would like to acknowledge the support of the Young urology researchers organisation (YURO) community of Australia and New Zealand for enabling this manuscript to progress to completion.
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study formal consent is not required.
About this article
Cite this article
Corfield, J., Perera, M., Bolton, D. et al. 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol 36, 519–527 (2018). https://doi.org/10.1007/s00345-018-2182-1
- Prostate cancer
- Positron emission tomography
- Prostate-specific membrane antigen