Abstract
Background: Prostate-specific membrane antigen (PSMA)-targeted 2-(3-{1-carboxy-5-[(6-[18F] fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography/computed tomography (PET/CT) has shown advantages in primary staging, restaging, and metastasis detection of prostate cancer (PCa). However, little is known about the role of 18F-DCFPyL PET/CT in biochemically recurrent prostate cancer (BRPCa). Hence, we performed a systematic review and meta-analysis to evaluate 18F-DCFPyL PET/CT as first-line imaging modality in early detection of BRPCa.Methods: A comprehensive literature search of PubMed, Web of Science, Embase, and Cochrane Library was conducted until December 2020. The pooled detection rate on a per-person basis and together with 95% confidence interval (CI) was calculated. Furthermore, a prostate-specific antigen (PSA)-stratified performance of detection positivity was obtained to assess the sensitivity of 18F-DCFPyL PET/CT in BRPCa with different PSA levels.Results: A total of nine eligible studies (844 patients) were included in this meta-analysis. The pooled detection rate (DR) of 18F-DCFPyL PET/CT in BRPCa was 81% (95% CI: 76.9–85.1%). The pooled DR was 88.8% for PSA ≥ 0.5 ng/ml (95% CI: 86.2–91.3%) and 47.2% for PSA < 0.5 ng/ml (95% CI: 32.6–61.8%). We also noticed that the regional lymph node was the most common site with local recurrence compared with other sites (45.8%, 95% CI: 42.1–49.6%). Statistical heterogeneity and publication bias were found.Conclusion: The results suggest that 18F-DCFPyL PET/CT has a relatively high detection rate in BRPCa. The results also indicate that imaging with 18F-DCFPyL may exhibit improved sensitivity in BRPCa with increased PSA levels. Considering the publication bias, further large-scale multicenter studies are warranted for validation.
Highlights
Prostate cancer (PCa) is the most common form of malignant tumor among men in the United States and the second most common cause of cancer-related deaths in aging men [1]
All included studies shared a similar type of patients evaluated and detailed techniques of 18F-DCFPyL positron emission tomography/computed tomography (PET/CT)
Several meta-analyses have evaluated the diagnostic performance of PET/CT in biochemically recurrent prostate cancer (BRPCa) [40,41,42,43,44,45], to our knowledge, this is the first systematic review that focuses on the role of 18F-DCFPyL Prostate-specific membrane antigen (PSMA) PET/CT in early detection of recurrent lesions in BRPCa patients
Summary
Prostate cancer (PCa) is the most common form of malignant tumor among men in the United States and the second most common cause of cancer-related deaths in aging men [1]. For post radical prostatectomy (RP), biochemical recurrence (BCR) is defined as two consecutive PSA values that are >0.2 ng/ml and rising [3]. The treatment of men with biochemically recurrent prostate cancer (BRPCa) should be based on radiographic characteristics and on personal clinical, pathologic, and genomic characteristics, and optimal timing of systemic therapy remains controversial [10], the early lesion localization of BRPCa is still essential to define disease distribution that could, in turn, help urologists make further possible clinical decisions including surgery, salvage radiation therapy (RT), androgen deprivation therapy (ADT), or chemotherapy. Pentanedioic acid (18F-DCFPyL) positron emission tomography/computed tomography (PET/CT) has shown advantages in primary staging, restaging, and metastasis detection of prostate cancer (PCa). We performed a systematic review and meta-analysis to evaluate 18F-DCFPyL PET/CT as first-line imaging modality in early detection of BRPCa
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