Head-to-head comparison of the Diagnostic Accuracy of Prostate specific Membrane Antigen Positron Emission Tomography (PSMAPET) and Conventional Imaging Modalities for the Initial Staging of Intermediate-to-High Risk Prostate Cancer: A Systematic Review and Meta-Analysis

Chow Kit Mun, So Wei Zheng, Lee Han Jie, Alvin Lee, Dominic Wei Ting Yap, Yemisi Takwoingi, Tay Kae Jack, Jeffrey Tuan, Thang Sue Ping, Winnie Lam, John Yuen, Nathan Lawrentschuk, Michael S. Hofman, Declan Murphy, Kenneth Chen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Context
Whether prostate-specific membrane antigen positron emission tomography (PSMA-PET) should replace conventional imaging modalities (CIM) for initial staging of intermediate-high risk prostate cancer (PCa) requires definitive evidence on their relative diagnostic abilities.

Objective
To perform head-to-head comparisons of PSMA-PET and CIM including multiparametric magnetic resonance imaging (mpMRI), computed tomography (CT) and bone scan (BS) for upfront staging of tumour, nodal, and bone metastasis.

Evidence acquisition
A search of the PubMed, EMBASE, CENTRAL, and Scopus databases was conducted from inception to December 2021. Only studies in which patients underwent both PSMA-PET and CIM and imaging was referenced against histopathology or composite reference standards were included. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist and its extension for comparative reviews (QUADAS-C). Pairwise comparisons of the sensitivity and specificity of PSMA-PET versus CIM were performed by adding imaging modality as a covariate to bivariate mixed-effects meta-regression models. The likelihood ratio test was applied to determine whether statistically significant differences existed.

Evidence synthesis
A total of 31 studies (2431 patients) were included. PSMA-PET/MRI was more sensitive than mpMRI for detection of extra-prostatic extension (78.7% versus 52.9%) and seminal vesicle invasion (66.7% versus 51.0%). For nodal staging, PSMA-PET was more sensitive and specific than mpMRI (73.7% versus 38.9%, 97.5% versus 82.6%) and CT (73.2% versus 38.5%, 97.8% versus 83.6%). For bone metastasis staging, PSMA-PET was more sensitive and specific than BS with or without single-photon emission computerised tomography (98.0% versus 73.0%, 96.2% versus 79.1%). A time interval between imaging modalities >1 month was identified as a source of heterogeneity across all nodal staging analyses.

Conclusions
Direct comparisons revealed that PSMA-PET significantly outperforms CIM, which suggests that PSMA-PET should be used as a first-line approach for the initial staging of PCa.

Patient summary
We reviewed direct comparisons of the ability of a scan method called PSMA-PET (prostate-specific membrane antigen positron emission tomography) and current imaging methods to detect the spread of prostate cancer outside the prostate gland. We found that PSMA-PET is more accurate for detection of the spread of prostate cancer to adjacent tissue, nearby lymph nodes, and bones.
Original languageEnglish
Number of pages13
JournalEuropean urology
Early online date7 Apr 2023
DOIs
Publication statusE-pub ahead of print - 7 Apr 2023

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