Departments of Urology.
Clin Nucl Med. 2022 Sep 1;47(9):755-762. doi: 10.1097/RLU.0000000000004228. Epub 2022 Apr 22.
Multiple tools are now available to determine the requirement for a biopsy to diagnose prostate cancer, and PET/CT with radiolabeled prostate-specific membrane antigen (PSMA)-targeting radiotracers has been recommended for detecting primary prostate cancer. Particularly, the radiotracer 18 F-PSMA-1007 was found to be more favorable for primary tumors compared with other PSMA-targeting radiotracers because of its low clearance via the urinary tract and better image resolution. Thus, we performed a systematic review and meta-analysis to more accurately evaluate the detection performance of 18 F-PSMA-1007 PET/CT in primary prostate cancer patients.
An update on the databases of PubMed/MEDLINE, EMBASE, and Cochrane Library for comprehensive literature search was performed on September 30, 2021. The pooling detection rate was calculated on a per-patient basis. The pooling median of the SUV max was analyzed from the included studies. Furthermore, the positive predictive value of 18 F-PSMA-1007 PET/CT with pathologic lesions was analyzed using the criterion standard.
Twelve studies (540 patients total) were included in the meta-analysis. The overall pooling detection rate of 18 F-PSMA-1007 per patient was 94%, and the pooling median of SUV max located at the intraprostate tumor was 16 (range, 3.7-77.7). The positive predictive value of 18 F-PSMA-1007 per lesion with histopathological validation was 0.90, detecting regional lymph node metastasis was 0.94, and detecting localized prostatic tumors was 0.84.
In the current meta-analysis, we revealed the excellent performance of 18 F-PSMA-1007 to detect localized prostatic tumor lesions and regional lymph node metastasis. Moreover, the uptake of localized tumors in primary prostate cancer was nearly liver uptake and may be considered a suspicious malignancy if it was equal to or greater than the liver uptake.
现在有多种工具可用于确定前列腺癌活检的需求，并且已推荐使用放射性标记的前列腺特异性膜抗原（PSMA）靶向放射性示踪剂 PET/CT 来检测原发性前列腺癌。特别是，与其他 PSMA 靶向放射性示踪剂相比，放射性示踪剂 18 F-PSMA-1007 由于其通过尿路清除率低和更好的图像分辨率，对原发性肿瘤更有利。因此，我们进行了系统评价和荟萃分析，以更准确地评估 18 F-PSMA-1007 PET/CT 在原发性前列腺癌患者中的检测性能。
我们于 2021 年 9 月 30 日对 PubMed/MEDLINE、EMBASE 和 Cochrane Library 数据库进行了更新，以进行全面的文献搜索。基于患者的个体情况计算了汇总检测率。对纳入的研究进行了 SUV max 中位数的分析。此外，还使用标准病理病变分析了 18 F-PSMA-1007 PET/CT 的阳性预测值。
12 项研究（总计 540 例患者）被纳入荟萃分析。18 F-PSMA-1007 患者的总体汇总检测率为 94%，前列腺内肿瘤的 SUV max 中位数为 16（范围为 3.7-77.7）。经组织病理学验证，18 F-PSMA-1007 每例病变的阳性预测值为 0.90，检测区域淋巴结转移的阳性预测值为 0.94，检测局限性前列腺肿瘤的阳性预测值为 0.84。
在当前的荟萃分析中，我们揭示了 18 F-PSMA-1007 检测局限性前列腺肿瘤和区域淋巴结转移的优异性能。此外，原发性前列腺癌中局部肿瘤的摄取与肝脏摄取几乎相同，如果等于或大于肝脏摄取，则可考虑为可疑恶性肿瘤。
