Metaanalysis of 68Ga-PSMA-11 PET Accuracy for the Detection of Prostate Cancer Validated by Histopathology

Abstract

68Ga-PSMA-11 PET is used to stage patients with prostate cancer. We performed an updated metaanalysis that separates imaging at the time of diagnosis and at the time of biochemical recurrence and focuses on pathology correlation in both populations. Methods: We searched the MEDLINE and EMBASE databases using the PRISMA statement. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool 2. In total, 1,811 studies were screened, 58 were analyzed, 41 were included for qualitative synthesis, and 29 were included for quantitative analysis. A random-effect model and a hierarchical summary receiver-operating-characteristic model were used to summarize the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy for pelvic lymph nodes in initial staging compared with pathology at prostatectomy and the PPV for lesions with pathologic correlation in those with biochemical recurrence. We also summarized the detection rate of 68Ga-PSMA-11 in those with biochemical recurrence stratified by prostate-specific antigen (PSA) at the time of imaging. Results: The metaanalysis of 68Ga-PSMA-11 at initial staging demonstrated a sensitivity and specificity of 0.74 (95% confidence interval [95% CI], 0.51-0.89) and 0.96 (95% CI, 0.85-0.99), respectively, using nodal pathology at prostatectomy as a gold standard. At biochemical recurrence, the PPV was 0.99 (95% CI, 0.96-1.00). The detection rate was 0.63 (95% CI, 0.55-0.70), with a PSA of less than 2.0 and 0.94 (95% CI, 0.91-0.96) with a PSA of more than 2.0. Conclusion:68Ga-PSMA-11 performed well for the localization of metastatic prostate cancer at initial staging and at the time of biochemical recurrence.

Keywords: GU; PET; PSMA; molecular imaging; oncology; prostate cancer.

© 2019 by the Society of Nuclear Medicine and Molecular Imaging.

Figures

FIGURE 1.

PRISMA flow diagram depicting process for selecting papers included in this metaanalysis.

FIGURE 2.

Summary of sensitivity, specificity, and hierarchical summary receiver-operating-characteristic (HSROC) curve for 68Ga-PSMA-11 for initial staging of intermediate- to high-risk prostate cancer patients before prostatectomy for malignancy in pelvic nodes, with pathology at time of prostatectomy as gold standard. Effect size for sensitivity and specificity was 0.74 (95% CI, 0.51–0.89) and 0.96 (95% CI, 0.85–0.99), respectively. Size of circles represents size of individual studies.

FIGURE 3.

Forest plot of PPV for 68Ga-PSMA-11 in biochemical recurrence patients who have pathologic correlation for gold standard comparison. Overall effect size (ES) for PPV is 0.99 (95% CI, 0.96–1.00). Size of squares represents size of individual studies. Reference numbers are in Table 3.

FIGURE 4.

Forest plot of detection rate for 68Ga-PSMA-11 in biochemical recurrence patients. Effect size (ES) for detection rate is 0.63 (95% CI, 0.55–0.70) for PSA < 2.0 ng/dL and 0.94 (95% CI, 0.91–0.96) for PSA > 2.0 ng/dL. Size of squares represents size of individual studies. Reference numbers are in Table 3.