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Meta-Analysis
. 2024 Dec;27(4):654-664.
doi: 10.1038/s41391-023-00755-2. Epub 2023 Nov 28.

Comparison of 18F-based PSMA radiotracers with [68Ga]Ga-PSMA-11 in PET/CT imaging of prostate cancer-a systematic review and meta-analysis

Siyu Huang  1 , Sean Ong  2   3 , Dean McKenzie  4   5 , Adam Mirabelli  2 , David C Chen  6   7   8 , Thilakavathi Chengodu  3 , Declan G Murphy  7   9 , Michael S Hofman  6   7 , Nathan Lawrentschuk  2   3   10 , Marlon Perera  9   11
Affiliations
Meta-Analysis

Comparison of 18F-based PSMA radiotracers with [68Ga]Ga-PSMA-11 in PET/CT imaging of prostate cancer-a systematic review and meta-analysis

Siyu Huang et al. Prostate Cancer Prostatic Dis. 2024 Dec.

Abstract

Background: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) has become an increasingly established imaging modality in the staging of prostate cancer (PCa). Numerous PSMA-based tracers are currently available, however, there is a lack of consensus on the optimal radiotracer(s) for PSMA PET/CT. This study aims to investigate whether Fluorine-18 (18F)-labelled PSMA PET/CT is significantly different from Gallium-68 (68Ga) in primary diagnosis and/or secondary staging of prostate cancer following biochemical recurrence.

Methods: A critical review of MEDLINE, EMBASE, PubMed and Web of Science databases was performed in May 2023 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Studies that directly compared 18F-based PSMA radiotracers and [68Ga]Ga-PSMA-11 in terms of the normal organ SUV or the lesion SUV or the detection rate were assessed. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

Results: Twenty-four studies were analysed. [18F]DCFPyL and [18F]PSMA-1007 were the two most commonly studied 18F based PSMA tracers. [18F]JK-PSMA-7, [18F]rhPSMA-7, [18F]AlF-PSMA-11 were the new tracers evaluated in a limited number of studies. Overall, [18F]DCFPyL was observed to have a similar lesion detection rate to [68Ga]Ga-PSMA-11 with no increase in false positive rates. [18F]PSMA-1007 was found to have a greater local lesion detection rate because of its predominant hepatobiliary excretory route. However, [68Ga]Ga-PSMA-11 was observed to have a similar local lesion detection rate in studies that administer patients with furosemide prior to the scan. In addition, [18F]PSMA-1007 was found to have a significant number of benign bone uptakes.

Conclusions: [18F]DCFPyL was observed to be similar to [68Ga]Ga-PSMA-11. [18F]PSMA-1007 was observed to be less preferrable to [68Ga]Ga-PSMA-11 due to its high benign bone uptakes. Overall, there was not enough evidence in differentiating the radiotracers based on their clinical impacts.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Publication bias.
Funnel plots assessing publication bias in (A) [18F]PSMA-1007 and (B) [18F]DCFPyL based studies.
Fig. 2
Fig. 2. Summary of the study selection process.
Studies were selected according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Results were summarised below.
Fig. 3
Fig. 3. Lesion SUVmax of [18F]PSMA-1007 vs [68Ga]Ga-PSMA-11.
Forest plot of the standard difference in means and 95% confidence interval of lesion SUVmax of [18F]PSMA-1007 in comparison with [68Ga]Ga-PSMA-11 on prostate-specific membrane antigen positron emission tomography (PSMA PET/CT) by primary staging and restaging after biochemical recurrence (BCR) of prostate cancer. ES effect size.
Fig. 4
Fig. 4. Benign bone SUVmax of [18F]PSMA-1007 vs [68Ga]Ga-PSMA-11.
Forest plot of the standard difference in means and 95% confidence interval of benign bone SUVmax of [18F]PSMA-1007 in comparison with [68Ga]Ga-PSMA-11 on prostate-specific membrane antigen position emission tomography (PSMA PET/CT) by primary staging and restaging after biochemical recurrence (BCR) of prostate cancer. ES effect size.
Fig. 5
Fig. 5. Lesion SUVmax of [18F]DCFPyL vs [68Ga]Ga-PSMA-11.
Forest plot of the standard difference in means and 95% confidence interval of lesion SUVmax of [18F]DCFPyL in comparison with [68Ga]Ga-PSMA-11 on prostate-specific membrane antigen positron emission tomography (PSMA PET/CT) by primary staging and restaging after biochemical recurrence (BCR) of prostate cancer. ES effect size.
See this image and copyright information in PMC

References

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