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. 2020 Jan 23;20(1):10.
doi: 10.1186/s40644-020-0290-9.

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Lars J Petersen  1   2 , Helle D Zacho  3   4
Affiliations

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

Lars J Petersen et al. Cancer Imaging. .

Abstract

Background: PSMA PET is a promising method for primary lymph node staging in prostate cancer. However, recent systematic reviews have identified only a limited number of studies with histopathology as a reference test.

Methods: A systematic search was performed in PubMed and the Cochrane Library. An expedited systematic review was performed where we identified diagnostic studies in prostate cancer where a preoperative PSMA PET for primary lymph node staging was compared to histopathology. The trials must have diagnostic data on a patient level.

Results: Eighteen eligible clinical trials included 969 patients. The median patient number per study was 32 (range 10 to 208). Five trials were prospective, and nine trials had a consecutive enrolment of patients. Sixteen studies used Ga-68-PSMA-11; there was one study with Cu-64-PSMA and one study with F-18-DCDFPyL. Twelve studies used PET/CT, four trials used PET/MR. Most trials included patients with intermediate and high-risk. Diagnostic accuracy varied notably among the studies; sensitivity ranged from 23 to 100%, specificity 67-100%, positive predictive value 20-100%, and negative predictive value 41-100%. Weighted sensitivity was 59%, weighted specificity was 93%. Four studies compared PSMA PET with anatomical imaging (CT or MRI); in all cases, sensitivity and specificity were superior with PSMA PET. Three studies compared PSMA PET with multi-parametric or diffusion-weighted MRI with mixed results.

Conclusions: PSMA PET showed promising diagnostic accuracy for primary lymph node staging with pathology as reference. Recommendation for PSMA PET for high-risk patients in clinical guidelines should be supported by confirmatory, prospective trials with patient-relevant outcomes.

Keywords: Diagnostic accuracy; Lymph node metastasis; Positron emission tomography; Prostate cancer; Prostate-specific membrane antigen; Staging.

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Conflict of interest statement

The authors declare that they have no competing interests.

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