Head-to-head comparison of PSMA PET/CT and mpMRI for detecting biochemical recurrence of prostate cancer: A systematic review and meta-analysis

Abstract

Objectives: This study aimed to evaluate the performance of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) in comparison to multiparametric magnetic resonance imaging (mpMRI) for detecting biochemical recurrence of prostate cancer (PCa).

Materials and methods: We conducted a comprehensive search for articles published in PubMed, Web of Science, Embase, and the Cochrane Library, spanning the inception of the database until October 26, 2022, which included head-to-head comparisons of PSMA PET/CT and mpMRI for assessing the biochemical recurrence of PCa.

Results: A total of 5 studies including 228 patients were analyzed. The overall positivity rates of PSMA PET/CT and mpMRI for detecting biochemical recurrence of PCa after final treatment were 0.68 (95% confidence interval [CI], 0.52-0.89) and 0.56 (95% CI, 0.36-0.88), respectively. The positivity rates of PSMA PET/CT and mpMRI for detecting local recurrence, lymph node metastasis, and bone metastases were 0.37 (95% CI, 0.30-0.47) and 0.38 (95% CI, 0.22-0.67), 0.44 (95% CI, 0.35-0.56) and 0.25 (95% CI, 0.17-0.35), and 0.19 (95% CI, 0.11-0.31) and 0.12 (95% CI, 0.05-0.25), respectively. Compared with mpMRI, PSMA PET/CT exhibited a higher positivity rate for detecting biochemical recurrence and lymph node metastases, and no significant difference in the positivity rate of local recurrence was observed between these 2 imaging modalities.

Conclusions: Compared with mpMRI, PSMA PET/CT appears to have a higher positivity rate for detecting biochemical recurrence of PCa. Although both imaging methods showed similar positivity rates of detecting local recurrence, PSMA PET/CT outperformed PSMA PET/CT in detecting lymph node involvement and overall recurrence.

Keywords

Prostate- specific membrane antigen / Positron emission tomography/computed tomography / Multiparametric magnetic resonance imaging / Prostate cancer / Biochemical recurrence / Positive rate

Acknowledgments

None.

Statement of ethics

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Conflict of interest statement

The authors have no relevant financial or nonfinancial interests to disclose.

Funding source

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author contributions

XZ, ZM: Material preparation, data collection, and analysis;

XZ: Writing of the first draft of the manuscript;

XZ, ZM: Study conception and design;

XZ, ZM: Commenting on previous versions of the manuscript;

XZ, ZM: Reading and approval of the final manuscript.

Data availability

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.

References

[1] Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: Profiles, trends, and determinants. Chin Med J (Engl) 2022; 135(5):584-590.

[2] Sebesta EM, Anderson CB. The surgical management of prostate cancer. Semin Oncol 2017; 44(5):347-357.

[3] Rosenbaum E, Partin A, Eisenberger MA. Biochemical relapse after primary treatment for prostate cancer: Studies on natural history and therapeutic considerations. J Natl Compr Canc Netw 2004; 2(3):249-256.

[4] Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281(17):1591-1597.

[5] Fendler WP, Eiber M, Beheshti M, et al. PSMA PET/CT: Joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. Eur J Nucl Med Mol Imaging 2023; 50(5):1466-1486.

[6] Rayn KN, Elnabawi YA, Sheth N. Clinical implications of PET/CT in prostate cancer management. Transl Androl Urol 2018; 7(5):844-854.

[7] Morawitz J, Kirchner J, Lakes J, et al. PSMA PET/CT vs. CT alone in newly diagnosed biochemical recurrence of prostate cancer after radical prostatectomy: Comparison of detection rates and therapeutic implications. Eur J Radiol 2021;136:109556.

[8] Fendler WP, Eiber M, Beheshti M, et al. ⁶⁸Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: Version 1.0. Eur J Nucl Med Mol Imaging 2017; 44(6):1014-1024.

[9] Stabile A, Giganti F, Rosenkrantz AB, et al. Multiparametric MRI for prostate cancer diagnosis: Current status and future directions. Nat Rev Urol 2020; 17(1):41-61.

[10] Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 2009;339:b2700.

[11] Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155(8):529-536.

[12] Emmett L, Metser U, Bauman G, et al. Prospective, multisite, international comparison of ¹⁸F-fluoromethylcholine PET/CT, multiparametric MRI, and ⁶⁸Ga- HBED-CC PSMA-11 PET/CT in men with high-risk features and biochemical failure after radical prostatectomy: Clinical performance and patient outcomes. J Nucl Med 2019; 60(6):794-800.

[13] Saule L, Radzina M, Liepa M, et al. Diagnostic scope of ¹⁸F- PSMA-1007 PET/CT: Comparison with multiparametric MRI and bone scintigraphy for the assessment of early prostate cancer recurrence. Am J Nucl Med Mol Imaging 2021; 11(5):395-405.

[14] Radzina M, Tirane M, Roznere L, et al. Accuracy of ⁶⁸Ga- PSMA-11 PET/CT and multiparametric MRI for the detection of local tumor and lymph node metastases in early biochemical recurrence of prostate cancer. Am J Nucl Med Mol Imaging 2020; 10(2):106-118.

[15] Afshar-Oromieh A, Vollnberg B, Alberts I, et al. Comparison of PSMA-ligand PET/CT and multiparametric MRI for the detection of recurrent prostate cancer in the pelvis. Eur J Nucl Med Mol Imaging 2019; 46(11):2289-2297.

[16] Tseng JR, Yu KJ, Liu FY, et al. Comparison between ⁶⁸Ga- PSMA-11 PET/CT and multiparametric magnetic resonance imaging in patients with biochemically recurrent prostate cancer following robot-assisted radical prostatectomy. J Formos Med Assoc 2021; 120(1 Pt3):688-696.

[17] Trabulsi EJ, Rumble RB, Jadvar H, et al. Optimum imaging strategies for advanced prostate cancer: ASCO guideline. J Clin Oncol 2020; 38(17):1963-1996.

[18] Sighinolfi MC, Rocco B. Briers E et al. Reply to Alessia Cimadamore, Marina Scarpelli, Liang Cheng et al's letter to the editor, re: Maria Chiara Sighinolfi, Bernardo Rocco's words of wisdom re: EAU guidelines: Prostate cancer 2019. Mottet N, van den Bergh RCN, Briers E et al. Https://uroweb.org/guideline/prostate-Cancer/. Eur Urol 2019, 76:871. Eur Urol 2020;77(5):e128-e129

[19] Cornford P, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II-2020 update: Treatment of relapsing and metastatic prostate cancer. Eur Urol 2021; 79(2):263-282.

[20] Fanti S, Goffin K, Hadaschik BA, et al. Consensus statements on PSMA PET/CT response assessment criteria in prostate cancer. Eur J Nucl Med Mol Imaging 2021; 48(2):469-476.

[21] Farolfi A, Calderoni L, Mattana F, et al. Current and emerging clinical applications of PSMA PET diagnostic imaging for prostate cancer. J Nucl Med 2021; 62(5):596-604.

[22] Diao W, Cai H, Chen L, Jin X, Liao X, Jia Z. Recent advances in prostate-specific membrane antigen-based radiopharmaceuticals. Curr Top Med Chem 2019; 19(1):33-56.

[23] Eder M, Schäfer M, Bauder-Wüst U, et al. ⁶⁸Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 2012; 23(4):688-697.

[24] Prasad V, Steffen IG, Diederichs G, Makowski MR, Wust P, Brenner W. Biodistribution of [⁽⁶⁸⁾Ga]PSMA-HBED-CC in patients with prostate cancer: Characterization of uptake in normal organs and tumour lesions. Mol Imaging Biol 2016; 18(3):428-436.

[25] Afshar-Oromieh A, Malcher A, Eder M, et al. PET imaging with a [⁶⁸Ga]gallium- labelled PSMA ligand for the diagnosis of prostate cancer: Biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013; 40(4):486-495.

[26] Oh SW, Cheon GJ. Prostate-specific membrane antigen PET imaging in prostate cancer: Opportunities and challenges. Korean J Radiol 2018; 19(5):819-831.

[27] Giesel FL, Knorr K, Spohn F, et al. Detection efficacy of ¹⁸F-PSMA-1007 PET/CT in 251 patients with biochemical recurrence of prostate cancer after radical prostatectomy. J Nucl Med 2019; 60(3):362-368.

[28] Giesel FL, Hadaschik B, Cardinale J, et al. F-18 labelled PSMA-1007: Biodistribution, radiation dosimetry and histopathological validation of tumor lesions in prostate cancer patients. Eur J Nucl Med Mol Imaging 2017; 44(4):678-688.