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.

Publisher: Springer International Country of Publication: Germany NLM ID: 9114774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1084 (Electronic) Linking ISSN: 09387994 NLM ISO Abbreviation: Eur Radiol Subsets: MEDLINE

Original Publication: Berlin : Springer International, c1991-

Prostatic Neoplasms*/diagnostic imaging ; Prostatic Neoplasms*/pathology ; Multiparametric Magnetic Resonance Imaging*/methods ; Positron-Emission Tomography*/methods ; Sensitivity and Specificity*; Humans ; Male ; Antigens, Surface/metabolism ; Glutamate Carboxypeptidase II/metabolism

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.
(© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Comment in: Eur Radiol. 2024 Jun;34(6):4014-4016. doi: 10.1007/s00330-023-10547-w. (PMID: 38165433)

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82125025 National Natural Science Foundation of China; SHDC12022117 Shanghai Shenkang Hospital Development Center; SHDC2022CRT005 Shanghai Shenkang Hospital Development Center

Keywords: Meta-analysis; Multiparametric magnetic resonance imaging; Positron emission tomography; Prostate cancer; Prostate-specific membrane antigen

EC 3.4.17.21 (FOLH1 protein, human)
0 (Antigens, Surface)
EC 3.4.17.21 (Glutamate Carboxypeptidase II)

Date Created: 20231119 Date Completed: 20240611 Latest Revision: 20240618

20240618

10.1007/s00330-023-10436-2

37981590