Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia.
Eur Urol. 2020 Apr;77(4):403-417. doi: 10.1016/j.eururo.2019.01.049. Epub 2019 Feb 14.
Accurate staging of high-risk localised, advanced, and metastatic prostate cancer is becoming increasingly more important in guiding local and systemic treatment. Gallium-68 prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has increasingly been utilised globally to assess the local and metastatic burden of prostate cancer, typically in biochemically recurrent or advanced disease. Following our previous meta-analysis, a high-volume series has been reported highlighting the utility of Ga-PSMA PET in this setting.
To perform a systematic review and meta-analysis to update reported predictors of positive Ga-PSMA PET according to prior therapy and proportion of positivity in various anatomical locations with sensitivity and specificity profiles.
We performed critical reviews of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, and Web of Science databases in July 2018 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using Quality Assessment if Diagnostic Accuracy Studies-2 tool. Meta-analyses of proportions were performed using a random-effect model. Summary sensitivity and specificity values were obtained by fitting bivariate hierarchical regression models.
A total of 37 articles including 4790 patients were analysed. For patients with biochemical recurrence, positive Ga-PSMA PET scans increased with higher pre-PET prostate-specific antigen (PSA) levels. For PSA categories 0-0.19, 0.2-0.49, 0.5-0.99, 1-1.99, and ≥2ng/ml, the percentages of positive scans were 33%, 45%, 59%, 75%, and 95%, respectively. No significant differences in positivity were noted between Gleason sums ≤7 and ≥8. Significant differences in positivity after biochemical recurrence in the prostate bed were noted between radical prostatectomy (22%) and radiotherapy (52%) patients. On per-node analysis, high sensitivity (75%) and specificity (99%) were observed.
Ga-68-PSMA PET improves detection of metastases with biochemical recurrence, particularly at low pre-PET PSA levels of >0.2ng/ml (33%) and 0.2-0.5ng/ml (45%). Ga-68-PSMA-PET produces favourable sensitivity and specificity profiles on meta-analysis of pooled data. This analysis highlights different anatomic patterns of metastatic spread according to PSMA PET in the primary and biochemically recurrent settings.
Gallium-68 prostate-specific membrane antigen positron emission tomography is now an established imaging technique that has been developed in response to inadequacies in standard of care imaging modalities to improve the detection of metastatic disease in prostate cancer, particularly in the setting of disease recurrence. To date, this imaging modality in the setting of primary staging is controversial, given the paucity of data. In light of the growing body of evidence, we summarised the data to date to provide clinicians with an overview of this imaging modality.
准确分期高危局限性、晚期和转移性前列腺癌在指导局部和全身治疗方面变得越来越重要。镓-68 前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）在全球范围内越来越多地用于评估前列腺癌的局部和转移性负担，通常用于生化复发或晚期疾病。继我们之前的荟萃分析之后，已经报道了一系列大量的研究，强调了 Ga-PSMA PET 在这种情况下的实用性。
进行系统评价和荟萃分析，根据既往治疗和各种解剖部位的阳性率更新报告的阳性 Ga-PSMA PET 的预测因素，并评估其敏感性和特异性。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，我们于 2018 年 7 月对 MEDLINE、EMBASE、ScienceDirect、Cochrane 图书馆和 Web of Science 数据库进行了批判性评价。使用诊断准确性研究的质量评估工具-2 工具进行质量评估。使用随机效应模型进行比例荟萃分析。通过拟合双变量层次回归模型获得总结敏感性和特异性值。
共分析了 37 篇文章，包括 4790 名患者。对于生化复发患者，Ga-PSMA PET 扫描阳性率随着预 PET 前列腺特异性抗原（PSA）水平的升高而增加。对于 PSA 类别 0-0.19、0.2-0.49、0.5-0.99、1-1.99 和≥2ng/ml，阳性扫描的百分比分别为 33%、45%、59%、75%和 95%。Gleason 总和≤7 和≥8 之间的阳性率无显著差异。生化复发前列腺床的阳性率在根治性前列腺切除术（22%）和放疗（52%）患者之间有显著差异。在逐个节点分析中，观察到高敏感性（75%）和特异性（99%）。
Ga-68-PSMA PET 提高了生化复发时转移的检测率，尤其是在 PSA 水平>0.2ng/ml（33%）和 0.2-0.5ng/ml（45%）时。Ga-68-PSMA-PET 在汇总数据的荟萃分析中产生了有利的敏感性和特异性谱。该分析根据 PSMA PET 在原发性和生化复发环境中的表现，强调了转移性播散的不同解剖模式。
镓-68 前列腺特异性膜抗原正电子发射断层扫描现在是一种成熟的成像技术，它是为了弥补标准护理成像方式在检测前列腺癌转移疾病方面的不足而开发的，特别是在疾病复发的情况下。迄今为止，鉴于数据的缺乏，这种成像方式在原发性分期方面仍存在争议。鉴于越来越多的证据，我们总结了迄今为止的数据，为临床医生提供了对这种成像方式的概述。
