Abstract
PurposeProstate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE).MethodsPubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect.ResultsTwelve studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95% CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95% CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95% CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95% CI 0.84-0.97] vs. 0.96 [95% CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, −0.234-0.908] between sensitivity and false-positive rate).ConclusionPSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.
Highlights
Prostate cancer is the second most common cancer and the 5th leading cause of cancer-related deaths worldwide (Bray et al 2018)
Pubmed and Embase databases were systematically searched from inception until January 12, 2020, using keywords and related terms of “prostate”, “Prostate-specific membrane antigen (PSMA)-positron emission tomography (PET)”, “SVI”, and “EPE” based on the search query as the following: AND (“prostate-specific membrane antigen” OR PSMA) AND (“positron emission” OR PET) AND (“extracapsular extension” OR ECE OR “extraprostatic extension” OR EPE OR “seminal vesical invasion” OR SVI OR T3 OR T3a OR T3b OR ((local OR localized OR regional OR locoregional) AND))
Fulltext reviews were done on the remaining 26 articles, among which 16 studies were excluded owing to the following reasons: non-68Ga-based radioligands (18F–PSMA-1007) was used (n = 1), PSMA PET was correlated with clinical staging (n = 4), inter-observer agreement study (n = 2), an agreement between PET/magnetic resonance imaging (MRI) and PET/CT (n = 1), assessment of utility of CT urography together with PET (n = 1), comparison of standardized uptake value between tumor and nontumor (n = 1), no evaluation of local staging (n = 1), insufficient data for reconstructing 2 × 2 tables (n = 2), and overlap in patient population (n = 3)
Summary
Prostate cancer is the second most common cancer and the 5th leading cause of cancer-related deaths worldwide (Bray et al 2018). There is an increasing number of studies showing that incorporating preoperative magnetic resonance imaging (MRI) results provide incremental value in predicting SVI and EPE (Ohori et al 2004; Nyarangi-Dix et al 2018; Mehralivand et al 2019; Park et al 2020). These results are still imperfect with area under the curves (AUC) ranging from 0.74-0.87 (Jansen et al 2019; Wang et al 2007; Weaver et al 2018). There is an unmet clinical need to improve preoperative risk assessment in patients with prostate cancer
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