From the Department of Radiology, Loma Linda University Medical Center, 11234 Anderson St, Suite MC-2605E, Loma Linda, CA 92354 (N.T., U.O., N.F.); Riverside School of Medicine, University of California, Riverside, Calif (N.T., N.B.); Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (A.M., M.S.D.); and Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Calif (J.C.).
Radiology. 2020 Jul;296(1):44-55. doi: 10.1148/radiol.2020191689. Epub 2020 May 12.
Background National guidelines endorse fluorine 18 (F) fluciclovine PET/CT for the detection of prostate cancer (PCa) in men with biochemically recurrent PCa. The comparative performance between fluciclovine and gallium 68 or F prostate-specific membrane antigen (PSMA) PET/CT, a newer examination, is unclear. Purpose To compare the detection of biochemical recurrence using fluciclovine versus PSMA-targeted radiotracers in patients with a prostate-specific antigen (PSA) level less than 2 ng/mL. Materials and Methods With use of the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy, or PRISMA-DTA, guidelines, a systematic review of PubMed and EMBASE databases between 2012 and 2019 was performed. Studies of fluciclovine PET/CT or PSMA PET/CT in biochemical recurrence were identified. PSA levels, clinical data, and reference standards were obtained when available. A random-effects model was applied to pooled estimates and 95% confidence intervals (CIs) around the prevalence of a positive examination, stratified according to PSA tier. Results Quantitative analysis included 482 patients (median age, 67 years; interquartile range, 67-67 years) in six fluciclovine studies and 3217 patients (median age, 68 years; interquartile range, 67-70 years) in 38 PSMA studies. Pooled detection rates for PSMA and fluciclovine were 45% (95% CI: 38%, 52%) and 37% (95% CI: 25%, 49%), respectively, for a PSA level less than 0.5 ng/mL ( = .46); 59% (95% CI: 52%, 66%) and 48% (95% CI: 34%, 61%) for a PSA level of 0.5-0.9 ng/mL ( = .19); and 80% (95% CI: 75%, 85%) and 62% (95% CI: 54%, 70%) for a PSA level of 1.0-1.9 ng/mL ( = .01). A reference standard was positive in 703 of 735 patients (96%) in the PSMA cohort and 247of 256 (97%) in the fluciclovine cohort. Conclusion Patient-level detection rates for biochemically recurrent prostate cancer were greater for prostate-specific membrane antigen-targeted radiotracers than fluciclovine for prostate specific antigen levels of 1.0-1.9 ng/mL. © RSNA, 2020
背景 国家指南支持使用氟 18（F）氟戊醇 PET/CT 检测生化复发的前列腺癌（PCa）患者。氟戊醇与新型前列腺特异性膜抗原（PSMA）靶向放射性示踪剂相比，其性能尚不清楚。目的 比较氟戊醇与 PSMA 靶向放射性示踪剂在前列腺特异性抗原（PSA）水平<2ng/mL 的患者中检测生化复发的情况。材料与方法 采用 Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy，或 PRISMA-DTA 指南，对 2012 年至 2019 年期间 PubMed 和 EMBASE 数据库进行了系统评价。检索氟戊醇 PET/CT 或 PSMA PET/CT 用于生化复发的研究。获取 PSA 水平、临床数据和参考标准（如适用）。采用随机效应模型分析了阳性检查的汇总估计值和 95%置信区间（CI），并根据 PSA 分层进行了分层。结果 定量分析纳入了 6 项氟戊醇研究的 482 例患者（中位年龄 67 岁；四分位距，67-67 岁）和 38 项 PSMA 研究的 3217 例患者（中位年龄 68 岁；四分位距，67-70 岁）。PSA 水平<0.5ng/mL 时，PSMA 和氟戊醇的检测率分别为 45%（95%CI：38%，52%）和 37%（95%CI：25%，49%）（ =.46）；PSA 水平为 0.5-0.9ng/mL 时，分别为 59%（95%CI：52%，66%）和 48%（95%CI：34%，61%）（ =.19）；PSA 水平为 1.0-1.9ng/mL 时，分别为 80%（95%CI：75%，85%）和 62%（95%CI：54%，70%）（ =.01）。在 PSMA 组中，735 例患者中有 703 例（96%）和氟戊醇组中 256 例患者中有 247 例（97%）的参考标准为阳性。结论 对于 PSA 水平为 1.0-1.9ng/mL 的患者，与氟戊醇相比，PSMA 靶向放射性示踪剂的生化复发前列腺癌患者的检出率更高。
