Impact of 68Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis

Abstract

Context68Gallium prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET) is an emerging imaging modality for assessment of prostate cancer. Recent studies show promising results regarding its ability to detect recurrent or metastatic prostate cancer superior to that of conventional imaging modalities. However, the impact of 68Ga-PSMA PET on management of patients with prostate cancer has not been well established. ObjectiveTo perform a systematic review and meta-analysis to evaluate the impact of 68Ga-PSMA PET on management of patients with prostate cancer. Evidence acquisitionPubmed and EMBASE databases were searched up to January 20, 2018. We included studies that reported proportion of management change after 68Ga-PSMA PET in patients with prostate cancer. The quality of the studies was evaluated using the GRADE system. The proportion of management changes were pooled using random-effects model. Subgroup analyses and meta-regression analyses were performed to explore heterogeneity. Evidence synthesisFifteen studies (1163 patients) were included. The pooled proportion of management changes was 54% (95% confidence interval 47–60%). At meta-regression analyses, PET positivity (%) was a significant factor of heterogeneity (p=0.0486). For patients with biochemical failure, the proportion of radiotherapy (from 56% to 61%), surgery (from 1% to 7%), focal therapy (from 1% to 2%), and multimodal treatment (from 2% to 6%) increased, whereas that of systemic treatment (from 26% to 12%) and no treatment (from 14% to 11%) decreased with 68Ga-PSMA PET. Conclusions68Ga-PSMA PET had a large impact on the management of patients with prostate cancer. Greater PET positivity was associated with higher proportion of management changes. Patient summaryWe reviewed all previous studies assessing the impact of 68Gallium prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET) in patients with prostate cancer. We found that 68Ga-PSMA PET altered the management in approximately half of the patients.