Abstract
AbstractImaging with radiotracers targeting the prostate-specific membrane antigen (PSMA) receptor is identified as a promising novel technique in prostate cancer (PCa) detection. In this paper we aim to summarize the current knowledge derived from the literature as well as the authors’ experiences on PSMA PET/CT in initial staging of PCa. PSMA PET/CT lesion- and template-based sensitivity and specificity respectively ranged from 35.1–96.1% and 96–100%. Patient-based sensitivity and specificity respectively ranged from 33.3–100% and 95–100%. Accuracy was 92% (95% CI 88–95) versus 65% (95% CI 60–69) compared to conventional imaging (CT and skeletal scintigraphy). PSMA PET/CT is superior for detection of metastases in primary PCa compared to conventional imaging. Also, PSMA PET/CT has a high specificity and moderate sensitivity for lymph node detection in primary PCa. For adequate initial staging, extended pelvic lymph node dissection (ePLND) will still be required, however, PSMA PET/CT can induce important management changes.
Highlights
Prostate cancer (PCa) is the most commonly diagnosed cancer, affecting 1 in 9 men
We aimed to summarize the current knowledge derived from the literature as well as the authors’ experiences on prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) in initial staging of prostate cancer (PCa)
Despite its high specificity, PSMA positron emission tomography/computed tomography (PET/CT) had a moderate to low patient, and lesion-based sensitivity [19, 20, 26, 28, 33] indicating that a negative PSMA PET/CT cannot rule out lymph node metastasis and is not able to replace extended pelvic lymph node dissection (ePLND) for lymph node detection
Summary
Prostate cancer (PCa) is the most commonly diagnosed cancer, affecting 1 in 9 men. With 31,620 estimated deaths in 2019, PCa represents the secondranked cause of cancer mortality [1]. In the Netherlands, approximately 12,420 patients were newly diagnosed in 2018 [2]. Due to aging of the population, this proportion is expected to increase even further in 2025. Since metastases of PCa are characterized as an adverse prognostic factor [3], accurate staging is essential to select the most effective treatment strategy. To define TNM-stage, current international guidelines recommend intermediate- and high-risk PCa patients
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