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Review
. 2022 Oct 14;14(20):5036.
doi: 10.3390/cancers14205036.

The Role of [68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review

Matteo Caracciolo  1 , Angelo Castello  2 , Luca Urso  1   3 , Francesca Borgia  1   3 , Naima Ortolan  1   3 , Licia Uccelli  1   3 , Corrado Cittanti  1   3 , Massimo Castellani  2 , Mirco Bartolomei  1 , Massimo Lazzeri  4 , Egesta Lopci  5
Affiliations
Review

The Role of [68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review

Matteo Caracciolo et al. Cancers (Basel). .

Abstract

The purpose of the study is to systematically evaluate the evidence regarding the role of [68Ga]PSMA PET/CT for clinical suspicions of prostate cancer in patients with or without previous negative biopsy. We performed a critical review of PubMed and Web of Science according to the PRISMA statement. Eighteen publications were selected for inclusion in this analysis. QUADAS-2 evaluation was adopted for quality analyses. [68Ga]PSMA-11 was the radiotracer of choice in 15 studies, while [68Ga]PSMA-617 was used in another 3. In 8 articles, there was a direct comparison with mpMRI. The total number of patients included was 1379, ranging from 15 to 291, with a median age of 64 years (range: 42-90). The median baseline PSA value was 12.9 ng/mL, ranging from 0.85 to 4156 ng/mL. Some studies evaluated the PSMA uptake comparing the SUVmax of suspicious lesions with the SUVmax of the normal biodistribution to find out optimal cut-off points. In addition, some studies suggested a significant association between PSA levels, PSA density, and [68Ga]PSMA PET/CT finding. [68Ga]PSMA PET/CT seems to be more accurate in identifying primary prostate cancer with PSA values between 4 and 20 ng/mL than mpMRI. Moreover, in some trials, the combination of PSMA PET/CT and MRI improved the NPV in the detection of clinically significant prostate cancer (csPCa) than MRI alone. Our findings are limited by the small numbers of studies and patient heterogeneity. [68Ga]PSMA PET/CT is a promising technique in patients with clinical suspicion of PCa and precedent negative biopsy or contraindications to MRI. Furthermore, its use combined with MRI improves sensitivity for csPCa detection and can avoid unnecessary biopsies.

Keywords: 68Ga-prostate-specific membrane antigen; PET/CT; PSMA; clinically significant cancer; mpMRI; primary diagnosis; prostate cancer.

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Conflict of interest statement

Egesta Lopci reports receiving grants from Fondazione AIRC (Associazione Italiana per la Ricerca sul Cancro) and from the Italian Ministry of Health and faculty remuneration from ESMIT (European School of Multimodality Imaging and Therapy) and the MI&T congress. Angelo Castello reports receiving fellowships from Fondazione AIRC (Associazione Italiana per la Ricerca sul Cancro). All remaining authors have declared no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study following PRISMA guidelines.
Figure 2
Figure 2
Multipanel comparison between mpMRI (PI-RADS 3) and [68Ga]PSMA PET/CT (SUVmax 4.3; SUVratio to background 2.1) in a biopsy-naïve patient with PSA of 5.54 ng/mL. The highlighted lesion resulted in a GS 3+4 adenocarcinoma of the left prostatic lobe (white arrows). PSMA = prostate-specific membrane antigen; PET/CT = positron emission tomography/computed tomography; CE − MRI = contrast − enhanced MRI; DWI − MRI = diffusion − weighted imaging MRI.
See this image and copyright information in PMC

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