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19.08.2023 | Review Article

The diagnostic accuracy of radiolabeled PSMA-ligand PET for tumour staging in newly diagnosed prostate cancer patients compared to histopathology: a systematic review and meta-analysis

verfasst von: Farid Gossili, Anna Winther Mogensen, Tea Caroline Konnerup, Kirsten Bouchelouche, Ian Alberts, Ali Afshar-Oromieh, Helle D. Zacho

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 1/2023

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Abstract

Purpose

The current clinical recommendations posit the deployment of specific approved radiolabeled prostate-specific membrane antigen-ligand positron emission tomography (PSMA PET) for detecting metastatic prostate cancer during primary staging. Nevertheless, the precise efficacy of such ligands in localizing intraprostatic tumours (index tumour) and T-staging is not well established. Consequently, the objective of this inquiry is to ascertain the diagnostic accuracy of PSMA-PET in the tumour staging of newly diagnosed prostate cancer by means of a meta-analysis that integrates studies utilizing histological confirmation as the reference standard.

Methods

In this study, we conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases using a predefined collection of search terms. These terms included ‘PSMA PET’, ‘primary staging’, and ‘prostate cancer’. Subsequently, two independent reviewers evaluated all the studies based on predetermined inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Any disparities were resolved by a third reviewer. A random effects Sidik-Jonkman model was applied to conduct a meta-analysis and estimate the diagnostic accuracy on a per-patient basis, along with 95% confidence intervals. Moreover, an appraisal regarding the likelihood of publication bias and the impact of small-study effects was performed utilizing both Egger’s test and a graphical examination of the funnel plot.

Results

The present analysis comprised a total of twenty-three scientific papers encompassing 969 patients and involved their analysis by both qualitative and quantitative approaches. The results of this study demonstrated that the estimated diagnostic accuracy of PSMA PET/CT and PSMA PET/MRI, for the detection of intraprostatic tumours, regardless of the type of PSMA-ligand, was 86% (95% CI: 76–96%) and 97% (95% CI: 94–100%), respectively. Furthermore, the diagnostic accuracy for the detection of extraprostatic extension (EPE) was 73% (95% CI: 64–82%) and 77% (95% CI: 69–85%), while the diagnostic accuracy for the detection of seminal vesicle involvement (SVI) was 87% (95% CI: 80–93) and 90% (95% CI: 82–99%), respectively.

Conclusion

The present investigation has demonstrated that PSMA PET/MRI surpasses currently recommended multiparametric magnetic resonance imaging (mpMRI) in terms of diagnostic accuracy as inferred from a notable data trajectory, whereas PSMA-PET/CT exhibited comparable diagnostic accuracy for intraprostatic tumour detection and T-staging compared to mpMRI. Nevertheless, the analysis has identified certain potential limitations, such as small-study effects and a potential for publication bias, which may impact the overall conclusions drawn from this study.
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Literatur
1.
Zurück zum Zitat Global Burden of Disease Cancer C, Kocarnik JM, Compton K, Dean FE, Fu W, Gaw BL, et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022;8:420-44https://doi.org/10.1001/jamaoncol.2021.6987 Global Burden of Disease Cancer C, Kocarnik JM, Compton K, Dean FE, Fu W, Gaw BL, et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022;8:420-44https://​doi.​org/​10.​1001/​jamaoncol.​2021.​6987
2.
Zurück zum Zitat Fendler WP, Eiber M, Beheshti M, Bomanji J, Calais J, Ceci F, et al. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. European journal of nuclear medicine and molecular imaging. 2023. https://doi.org/10.1007/s00259-022-06089-w. Fendler WP, Eiber M, Beheshti M, Bomanji J, Calais J, Ceci F, et al. PSMA PET/CT: joint EANM procedure guideline/SNMMI procedure standard for prostate cancer imaging 2.0. European journal of nuclear medicine and molecular imaging. 2023. https://​doi.​org/​10.​1007/​s00259-022-06089-w.
7.
Zurück zum Zitat Bodar YJL, Zwezerijnen B, van der Voorn PJ, Jansen BHE, Smit RS, Kol SQ, et al. Prospective analysis of clinically significant prostate cancer detection with [(18)F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study. Eur J Nucl Med Mol Imaging. 2021https://doi.org/10.1007/s00259-021-05604-9 Bodar YJL, Zwezerijnen B, van der Voorn PJ, Jansen BHE, Smit RS, Kol SQ, et al. Prospective analysis of clinically significant prostate cancer detection with [(18)F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study. Eur J Nucl Med Mol Imaging. 2021https://​doi.​org/​10.​1007/​s00259-021-05604-9
11.
13.
Zurück zum Zitat Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Eighth edition. ed. Chichester, West Sussex, UK ; Hoboken, NJ: John Wiley & Sons, Inc.; 2017. Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Eighth edition. ed. Chichester, West Sussex, UK ; Hoboken, NJ: John Wiley & Sons, Inc.; 2017.
17.
Zurück zum Zitat Brauchli D, Singh D, Chabert C, Somasundaram A, Collie L. Tumour-capsule interface measured on 18F-DCFPyL PSMA positron emission tomography/CT imaging comparable to multi-parametric MRI in predicting extra-prostatic extension of prostate cancer at initial staging. J Med Imaging Radiat Oncol. 2020;64:829–38. https://doi.org/10.1111/1754-9485.13084.CrossRefPubMed Brauchli D, Singh D, Chabert C, Somasundaram A, Collie L. Tumour-capsule interface measured on 18F-DCFPyL PSMA positron emission tomography/CT imaging comparable to multi-parametric MRI in predicting extra-prostatic extension of prostate cancer at initial staging. J Med Imaging Radiat Oncol. 2020;64:829–38. https://​doi.​org/​10.​1111/​1754-9485.​13084.CrossRefPubMed
19.
Zurück zum Zitat Donato P, Roberts MJ, Morton A, Kyle S, Coughlin G, Esler R, et al. Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology. Eur J Nucl Med Mol Imaging. 2019;46:20–30. https://doi.org/10.1007/s00259-018-4160-7.CrossRefPubMed Donato P, Roberts MJ, Morton A, Kyle S, Coughlin G, Esler R, et al. Improved specificity with 68Ga PSMA PET/CT to detect clinically significant lesions “invisible” on multiparametric MRI of the prostate: a single institution comparative analysis with radical prostatectomy histology. Eur J Nucl Med Mol Imaging. 2019;46:20–30. https://​doi.​org/​10.​1007/​s00259-018-4160-7.CrossRefPubMed
26.
Zurück zum Zitat Sonni I, Felker ER, Lenis AT, Sisk AE, Bahri S, Allen-Auerbach MS, et al. Head-to-head comparison of (68)Ga-PSMA-11 PET/CT and mpMRI with histopathology gold-standard in the detection, intra-prostatic localization and local extension of primary prostate cancer: results from a prospective single-center imaging trial. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2021. https://doi.org/10.2967/jnumed.121.262398. Sonni I, Felker ER, Lenis AT, Sisk AE, Bahri S, Allen-Auerbach MS, et al. Head-to-head comparison of (68)Ga-PSMA-11 PET/CT and mpMRI with histopathology gold-standard in the detection, intra-prostatic localization and local extension of primary prostate cancer: results from a prospective single-center imaging trial. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2021. https://​doi.​org/​10.​2967/​jnumed.​121.​262398.
27.
Zurück zum Zitat Tragardh E, Simoulis A, Bjartell A, Jogi J. Tumor detection of 18F-PSMA-1007 in the prostate gland in patients with prostate cancer using prostatectomy specimens as reference method. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2021. https://doi.org/10.2967/jnumed.121.261993. Tragardh E, Simoulis A, Bjartell A, Jogi J. Tumor detection of 18F-PSMA-1007 in the prostate gland in patients with prostate cancer using prostatectomy specimens as reference method. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2021. https://​doi.​org/​10.​2967/​jnumed.​121.​261993.
31.
Zurück zum Zitat Chen MX, Zhang Q, Zhang CW, Zhou YH, Zhao XZ, Fu Y, et al. Comparison of Ga-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and multi-parametric magnetic resonance imaging (MRI) in the evaluation of tumor extension of primary prostate cancer. Trans Androl Urol. 2020;9:382. https://doi.org/10.21037/tau.2020.03.06.CrossRef Chen MX, Zhang Q, Zhang CW, Zhou YH, Zhao XZ, Fu Y, et al. Comparison of Ga-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and multi-parametric magnetic resonance imaging (MRI) in the evaluation of tumor extension of primary prostate cancer. Trans Androl Urol. 2020;9:382. https://​doi.​org/​10.​21037/​tau.​2020.​03.​06.CrossRef
35.
Zurück zum Zitat von Klot CAJ, Merseburger AS, Böker A, Schmuck S, Ross TL, Bengel FM, et al. 68Ga-PSMA PET/CT imaging predicting intraprostatic tumor extent, extracapsular extension and seminal vesicle invasion prior to radical prostatectomy in patients with prostate cancer. Nucl Med Mol Imaging. 2017;51:314–22. https://doi.org/10.1007/s13139-017-0476-7.CrossRef von Klot CAJ, Merseburger AS, Böker A, Schmuck S, Ross TL, Bengel FM, et al. 68Ga-PSMA PET/CT imaging predicting intraprostatic tumor extent, extracapsular extension and seminal vesicle invasion prior to radical prostatectomy in patients with prostate cancer. Nucl Med Mol Imaging. 2017;51:314–22. https://​doi.​org/​10.​1007/​s13139-017-0476-7.CrossRef
43.
Zurück zum Zitat Martini A, Gupta A, Lewis SC, Cumarasamy S, Haines KG 3rd, Briganti A, et al. Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int. 2018;122:1025–33. https://doi.org/10.1111/bju.14353.CrossRefPubMed Martini A, Gupta A, Lewis SC, Cumarasamy S, Haines KG 3rd, Briganti A, et al. Development and internal validation of a side-specific, multiparametric magnetic resonance imaging-based nomogram for the prediction of extracapsular extension of prostate cancer. BJU Int. 2018;122:1025–33. https://​doi.​org/​10.​1111/​bju.​14353.CrossRefPubMed
45.
Zurück zum Zitat Roethke M, Kaufmann S, Kniess M, Ketelsen D, Claussen CD, Schlemmer HP, et al. Seminal vesicle invasion: accuracy and analysis of infiltration patterns with high-spatial resolution T2-weighted sequences on endorectal magnetic resonance imaging. Urol Int. 2014;92:294–9. https://doi.org/10.1159/000353968.CrossRefPubMed Roethke M, Kaufmann S, Kniess M, Ketelsen D, Claussen CD, Schlemmer HP, et al. Seminal vesicle invasion: accuracy and analysis of infiltration patterns with high-spatial resolution T2-weighted sequences on endorectal magnetic resonance imaging. Urol Int. 2014;92:294–9. https://​doi.​org/​10.​1159/​000353968.CrossRefPubMed
50.
Zurück zum Zitat Raveenthiran S, Yaxley WJ, Franklin T, Coughlin G, Roberts M, Gianduzzo T, et al. Findings in 1,123 men with preoperative (68)Ga-prostate-specific membrane antigen positron emission tomography/computerized tomography and multiparametric magnetic resonance imaging compared to totally embedded radical prostatectomy histopathology: implications for the diagnosis and management of prostate cancer. The Journal of urology. 2021. https://doi.org/10.1097/ju.0000000000002293. Raveenthiran S, Yaxley WJ, Franklin T, Coughlin G, Roberts M, Gianduzzo T, et al. Findings in 1,123 men with preoperative (68)Ga-prostate-specific membrane antigen positron emission tomography/computerized tomography and multiparametric magnetic resonance imaging compared to totally embedded radical prostatectomy histopathology: implications for the diagnosis and management of prostate cancer. The Journal of urology. 2021. https://​doi.​org/​10.​1097/​ju.​0000000000002293​.
52.
Zurück zum Zitat Alberts I, Mingels C, Zacho HD, Lanz S, Schoder H, Rominger A, et al. Comparing the clinical performance and cost efficacy of [(68)Ga]Ga-PSMA-11 and [(18)F]PSMA-1007 in the diagnosis of recurrent prostate cancer: a Markov chain decision analysis. Eur J Nucl Med Mol Imaging. 2022;49:4252–61. https://doi.org/10.1007/s00259-021-05620-9.CrossRefPubMed Alberts I, Mingels C, Zacho HD, Lanz S, Schoder H, Rominger A, et al. Comparing the clinical performance and cost efficacy of [(68)Ga]Ga-PSMA-11 and [(18)F]PSMA-1007 in the diagnosis of recurrent prostate cancer: a Markov chain decision analysis. Eur J Nucl Med Mol Imaging. 2022;49:4252–61. https://​doi.​org/​10.​1007/​s00259-021-05620-9.CrossRefPubMed
Metadaten
Titel
The diagnostic accuracy of radiolabeled PSMA-ligand PET for tumour staging in newly diagnosed prostate cancer patients compared to histopathology: a systematic review and meta-analysis
verfasst von
Farid Gossili
Anna Winther Mogensen
Tea Caroline Konnerup
Kirsten Bouchelouche
Ian Alberts
Ali Afshar-Oromieh
Helle D. Zacho
Publikationsdatum
19.08.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 1/2023
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-023-06392-0