ORIGINAL ARTICLE
Ahead of print publication  

The performance of 18F-PSMA PET/CT in the detection of prostate cancer: a systematic review and meta-analysis


1 Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
2 Department of Urology, Yancheng Third People's Hospital, Yancheng 224000, China
3 Department of Urology, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng 224000, China

Date of Submission03-Apr-2021
Date of Acceptance02-Aug-2021
Date of Web Publication29-Oct-2021

Correspondence Address:
Rui-Peng Jia,
Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006
China

Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aja202162

PMID: 34747721

  Abstract 


This paper presents a meta-analysis regarding the detection rate (DR) of fluorine-18 (18F)-labeled prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) in the management of patients with prostate cancer (PCa). Relevant studies regarding 18F-PSMA PET/CT in the management of PCa published until June 1, 2021, were electronically searched in online databases including EMBASE, PubMed, and Web of Science. The primary outcome was the DR of 18F-PSMA PET/CT in managing PCa patients, while the secondary outcome was the DR of 18F-PSMA PET/CT according to Gleason scores and serum prostate-specific antigen (PSA) level. The pooled DR was calculated on a per-patient basis, with pooled odd ratios and 95% confidence intervals (CIs). In total, 17 observational studies evaluating 1019 patients with PCa met the inclusion criteria. The DR of 18F-PSMA PET/CT was 0.83 (95% CI: 0.78–0.88), in the random-effects model. Subsequently, the analysis of DR of 18F-PSMA PET/CT in PCa patients using Gleason score (≤7 vs ≥8), showed a significant difference in PCa patients. Based on the above results, the higher Gleason score of PCa patients, the higher DR of 18F-PSMA PET/CT. The DR of 18F-PSMA PET/CT in PCa was 0.57 for PSA <0.5 ng ml−1; 0.75 for PSA ≥0.5 ng ml-1 and <1.0 ng ml-1; 0.93 for PSA ≥1.0 ng ml-1 and <2.0 ng ml-1; and 0.95 for PSA ≥2.0 ng ml−1. Therefore, the significant diagnostic value was found in terms of the DR of 18F-PSMA PET/CT in managing PCa patients and was associated with Gleason score and serum PSA level.

Keywords: 18F-PSMA PET/CT; detection rate; meta-analysis; prostate cancer


Article in PDF

How to cite this URL:
Qin ZQ, Pan GJ, Xu Z, Wang H, Xu LW, Jia RP. The performance of 18F-PSMA PET/CT in the detection of prostate cancer: a systematic review and meta-analysis. Asian J Androl [Epub ahead of print] [cited 2021 Dec 8]. Available from: https://www.ajandrology.com/preprintarticle.asp?id=329727

Zhi-Qiang Qin, Gao-Jian Pan
These authors contributed equally to this work.



  Introduction Top


Prostate cancer (PCa) is one of the most frequently diagnosed cancers in men and the fifth leading cause of death worldwide. The incidence of PCa varies greatly depending on the continent.[1] In the recent past, incidences of PCa have been increasingly reported in regions like Asia, which were traditionally considered low-incidence areas.[1],[2] Regardless of this, the diagnostic rate of PCa is still low due to the existing suboptimal imaging modalities used for diagnosis and treatment.[3] There have been efforts to develop novel imaging tools that will promote diagnostic and therapeutic strategies for PCa.[4] Therapeutic and management options for PCa are highly informed by the accurate staging of primary or recurrent PCa.[5],[6] Various imaging tools and techniques have been employed to assess the progression of PCa.[7],[8] They include transrectal ultrasound (TRUS), computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy (BS), which have been recommended for the diagnosis of primary and recurrence PCa by the European Association of Urology (EAU).[9],[10] These imaging techniques are, however, not always effective for the early and reliable management of primary/recurrence PCa due to their low sensitivity and specificity.[10] Recently developed metabolic imaging techniques are aimed at improving the diagnosis of PCa when an increase in prostate-specific antigen (PSA) serum values is detected following curative primary treatments. In patients with low but rising values of PSA serum, after definitive local therapy, it is important to identify the sites of recurrence to maximize the effects of treatment. Therefore, imaging with radiotracers targeting the prostate-specific membrane antigen (PSMA) has received increasing attention as a promising novel technique for PCa detection.[6] The PSMA is a protein expressed in dysplastic prostate cells with expression levels of 100–1000 times that of normal cells. The overexpression of PSMA may further be caused by the advanced stage and grade of PCa.[11],[12] It is important to note that PSMA is not prostate-specific, and it may be expressed in other tissues and tumors.[11] The physiological expression of PSMA has also been revealed in the kidneys, the lacrimal and salivary glands, parts of the small and large intestines, the liver, the spleen, the neuronal ganglia, and various solid malignant and benign tumors.[13],[14]

The clinical breakthrough in PSMA-based imaging was achieved with the introduction of gallium-68 (68Ga)-PSMA-11 in May 2011 as a PET tracer.[15],[16] In addition to 68Ga, several PSMA ligands, such as fluorine-18 (18F) and copper-64 (64Cu), can be radiolabeled with various positron-emitter isotopes to produce positron emission tomography (PET) radiopharmaceuticals for PCa therapy. The 68Ga PSMA PET/CT method of imaging has rapidly spread worldwide and is regarded as a significant step forward in the detection of PCa.[16] It is characterized by excellent tumor uptake, low background signal, high specificity, and very fast pharmacokinetics. These features enhance superior tumor visibility compared with other imagings.[17],[18] Currently available [18]F-labeled PSMA agents (18F-PSMA-1007, 18F-DCFPyL, and 18F-DCFBC) provide a more accurate and earlier detection of prostate disease than conventional imaging.[2],[19],[20],[21] The labeling of PSMA agents as 18F has several advantages over 68Ga. They include a larger amount of activity from 18F production by cyclotron, compared with the limited activity of 68Ga derived from the elution of Germanium-68 (68Ge)/68Ga generators.[18],[19] This is in addition to improved image resolution and a longer half-life.[19] Due to the lower positron energy, the theoretical achievable resolution of 18F is relatively better compared to that of 68Ga.

To date, numerous studies have explored the detection rate (DR) of 68Ga-labeled PSMA PET/CT in PCa patients. Conversely, this study aimed to perform a meta-analysis concerning the DR of 18F-PSMA PET/CT in the management of patients with PCa.


  Materials and Methods Top


Research question

A meta-analysis was performed to explore the DR of 18F-PSMA PET/CT for PCa patients in the management of localized or metastatic PCa.

Search strategy

This study conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.[22] The existing studies from EMBASE, PubMed, and Web of Science electronic databases were searched from the inception of the databases to June 1, 2021. The search query was formulated based on the following keywords: “18F-PSMA” or “18F-prostate-specific membrane antigen” and “diagnosis accuracy” or “detection” and “management” and “PCa” or “prostate cancer”. Besides, we also hand-searched the relevant studies from the reference lists of the selected articles, to identify more relevant publications and avoid relevant information being missing. The search was only limited to human studies and no language restrictions were posted in the setting.

Inclusion and exclusion criteria

Studies were included based on “Patient/Intervention/Outcome/Study design” criteria:[22] (1) “patients” with PCa, regardless of the clinical setting of primary staging or biochemical failure (BCF; biochemical persistence or recurrence); (2) studies using 18F-PSMA PET/CT as an “intervention”; (3) patient-specific overall detection rate or proportion of PCa patients who experience change as an “outcome”; and (4) “study design” of clinical trials and prospective or retrospective studies published as original articles or brief communications.

The following were the exclusion criteria: (1) small number of patients (<10); (2) other publication types, including conference abstracts, review articles, editorials, and letters; (3) papers irrelevant to the research question; (4) insufficient information provided in the study to calculate the DR of 18F-PSMA PET/CT in the management of PCa; and (5) overlapping study population. In the case of overlapping study populations, the article that provided more comprehensive information required for this meta-analysis was included.

Data extraction and quality assessment

Data extraction and study quality assessment were conducted blindly by two researchers (ZQQ and GJP). In the case of any inconsistency occurring in the results, a third reviewer (ZX) was consulted to reach a consensus. For each eligible article, clinicopathological and 18F-PSMA PET/CT characteristics were extracted using a standardized form, as follows:

  1. Basic studies: origin (first author, publication year, patient enrolment period, institution, and country), design (prospective vs retrospective, and consecutive enrolment vs nonconsecutive), and methods for data acquisition (review of medical records vs questionnaires)
  2. Clinicopathological: number of patients, age, and level of serum PSA at initial diagnosis and before 18F-PSMA PET/CT, Gleason score, and clinical setting (primary staging vs BCF)
  3. PET: vendor, scanner model, ligands, injected dose, uptake time, acquisition time, and PET positivity (proportion of patients with positive 68Ga-PSMA PET scans).


Statistical analyses

The primary outcome of this meta-analysis was “the impact of 18F-PSMA PET/CT on the detection of PCa” according to the proportion of patients who had their PCa care changed following imaging findings detected on 18F-PSMA PET/CT. The secondary outcomes compared the DR of 18F-PSMA PET/CT in PCa patients, based on Gleason scores and the level of serum PSA. Pooled odds ratios (ORs) analyses were carried out using data retrieved from individual studies about the DR of 18F-PSMA PET/CT in the management of PCa. Pooled data were plotted with its specific 95% confidence interval (95% CI) values. A fixed-effects model (the Mantel–Haenszel method) or a random-effects model (the DerSimonian and Laird method) was used for statistical pooling of the data. During pooling, consideration was given to heterogeneity between the selected studies. The heterogeneity was assessed among studies using the χ2 test and the I2 statistic. The I2 value typically ranges from 0 (no observed heterogeneity) to 100% (maximal heterogeneity). If the heterogeneity across studies was not identified, then the fixed-effects model was used; otherwise, the random-effects model was used in the meta-analysis. All statistical analyses were performed using STATA software (version 12.0; StataCorp LP, College Station, TX, USA). P < 0.05 was regarded as statistically significant.


  Results Top


Literature search

In total, 486 articles were initially identified through a primary search of the relevant online databases and reference lists. After reviewing titles and abstracts, 424 articles were excluded. The remaining 62 articles were selected and reviewed in full-text version. Consequently, 45 full-text articles were excluded due to the following reasons: no original available data (n = 13), meta-analysis (n = 9), review articles (n = 20), and overlapping articles (n = 3). Ultimately, 17 full-text studies met the inclusion criteria and were involved in the present meta-analysis. The studies were accrued from May 2017 to June 2021.[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38] The literature search and selection procedure is presented in [Figure 1].
Figure 1: A flowchart showing the selection process.

Click here to view


Characteristics of included studies

The characteristics and methodology assessment of individual studies included in the meta-analysis are described in [Table 1]. Briefly, seven prospective and ten retrospective studies were included. To ensure homogenous calibration between sites, all articles were approved by the Ethics Committee of each university or hospital. The patients from the included studies were consecutive enrolment. Besides, the data acquisition was based on the review of medical records in all these studies. [Table 2] and [Table 3] show the clinicopathologic features and PET characteristics of individual studies included in this meta-analysis. The number of PCa patients ranged from 10 to 251, with ages of 45–86 years. Median levels of PSA reported before 18F-PSMA PET/CT in all the included studies ranged between 0.03 ng ml−1 and 1481 ng ml−1. Of the total studies, only six studies reported the outcomes separately for primary staging and BCF; ten studies reported outcomes for BCF; and one study reported outcomes for primary staging. Besides, PET positivity was reported in all studies,[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38] with values ranging from 60% to 100% (overall, 82.8%).
Table 1: Characteristics and methodology assessment of individual studies included in the meta-analysis

Click here to view
Table 2: Characteristics about fluorine-18-labeled prostate-specific membrane antigen positron emission tomography/computed tomography of individual studies included in the meta-analysis

Click here to view
Table 3: Patient characteristics of individual studies included in the meta-analysis

Click here to view


Quality assessment

A total of 17 articles, enrolling 1019 patients, were identified and included in the analysis. According to the random-effects model, the DR of 18F-PSMA PET/CT was 0.83 (95% CI: 0.78–0.88) increase in the odds of the management of PCa [Figure 2]a. Subsequently, the performance of 18F-PSMA PET/CT on the detection of PCa patients was compared with the DR of 18F-PSMA PET/CT based on Gleason scores and serum PSA level. The results of Gleason score showed that there was a statistically significant diagnostic value in two groups of PCa patients when using 18F-PSMA PET/CT in the management of PCa patients. In the PCa patients with Gleason scores ≤7, the DR of 18F-PSMA PET/CT in PCa management changes was 0.83 (95% CI: 0.72–0.93; [Figure 2]b). Moreover, in the PCa patients with Gleason scores ≥8, the DR of 18F-PSMA PET/CT prominently increased (OR: 0.89, 95% CI: 0.83–0.94; [Figure 2]c). In the subgroup analysis using serum PSA level, the DR of 18F-PSMA PET/CT in PCa was 0.57 for PSA <0.5 ng ml−1 (95% CI: 0.37–0.77; [Figure 3]a); 0.75 for PSA ≥0.5 ng ml-1 and <1.0 ng ml-1 (95% CI: 0.68–0.83; [Figure 3]b); 0.93 for PSA ≥1.0 ng ml-1 and <2.0 ng ml-1 (95% CI: 0.89–0.98; [Figure 3]c); and 0.95 for PSA ≥2.0 ng ml−1 (95% CI: 0.93–0.98; [Figure 3]d). It was therefore revealed that, the Gleason score or serum PSA level of PCa patients correlated with DR of 18F-PSMA PET/CT in the management of PCa.
Figure 2: Forest plots showing the detection rate of 18F-labeled prostate-specific membrane antigen positron emission tomography/computed tomography for prostate cancer based on Gleason scores. (a) All PCa-suspected patients; (b) Gleason scores ≤7; (c) Gleason scores ≥8. PCa: prostate cancer; 18F: fluorine-18; PCa: prostate cancer; CI: confidence interval; ES: Elastic Search.

Click here to view
Figure 3: Forest plots showing the detection rate of 18F-labeled prostate-specific membrane antigen positron emission tomography/computed tomography for prostate cancer based on serum PSA level. (a) PSA <0.5 ng ml−1; (b) 0.5 ng ml−1≤ PSA <1.0 ng ml−1; (c) 1.0 ng ml−1≤ PSA <2.0 ng ml−1; (d) PSA ≥2.0 ng ml−1. PSA: prostate-specific antigen; 18F: fluorine-18; CI: confidence interval; ES: Elastic Search.

Click here to view



  Discussion Top


In recent years, increased studies in cancer research have focused on the diagnosis of tumors, which includes but is not limited to serum biomarkers, tissue pathology examination, and imaging tools.[9],[10] It has emerged that the most ideal methods in the field of cancer screening should be specific, noninvasive, and convenient, especially at an early stage.[39] Screening tools such as PSA, DRE, TRUS, CT, and MRI are significant in the clinical diagnosis and management of PCa.[9],[10],[39] Previous studies have, however, found that morphologic imaging, such as TRUS and CT, is limited in terms of diagnostic value (management rate <5%), especially when the PSA levels are <20 ng ml−1 or the PSA velocity is <2 ng ml−1 per year. Their sensitivity to detecting local PCa relapse remains relatively low (25%–54%) and is only moderately improved with functional MRI techniques.[40],[41] Moreover, the sensitivity of CT and MRI for the management of lymph node metastases of PCa is reported to be 30%–80%.[42] In view of the low sensitivity of morphologic imaging, there has been an urgent need to find more effective and reliable diagnostic methods to better manage primary/recurrence PCa.[9],[10],[39] As a new method of staging and restaging PCa patients, recent studies have recommended 18F-PSMA PET/CT. This method has the potential to improve the management of approximately half of PCa patients.[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38] Elsewhere, studies have reported overexpression of PSMA in PCa tissue compared with normal tissue, which increased even further at advanced stage and grade of PCa.[15],[20] These findings suggest that PSMA is a novel and promising biomarker.[5],[20] Thus, this meta-analysis aimed to evaluate the DR of 18F-PSMA PET/CT in the management of patients with PCa.

Recently, some studies have evaluated the clinicopathologic characteristics of 18F-PSMA PET/CT in the management of PCa.[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38] Nevertheless, the study's outcomes remain inconsistent due to the relatively small sample size, the different ethnicities, and the possible limited effect of individual patient data in the 18F-PSMA PET/CT. The meta-analysis had explored the results of the DR of 18F-PSMA PET/CT in the management of biochemical recurrent PCa, but such studies remain unreliable due to the disparity between the individual studies involved.[43],[44] Limited research on 18F-PSMA PET/CT limits comprehensive understanding of the disparity in the management of PCa, based on Gleason scores and serum PSA level. The present study pooled data reported in various studies to explore the DR of 18F- PSMA PET/CT in the management of patients with PCa.

According to the current meta-analysis findings, the DR of 18F-PSMA PET/CT significantly increased in patients with PCa. The meta-analysis could also provide the most comprehensive information about different subgroups. Results of the stratified analysis using Gleason scores (≤7 or ≥8), suggested that higher DR of 18F-PSMA PET/CT was found in PCa patients with Gleason scores ≥8. In addition, the DR of 18F-PSMA PET/CT in PCa increased with the increase in the serum PSA level.

The present meta-analysis was not without limitations. First, there were a limited number of studies and an insufficient number of PCa patients for the meta-analysis. Thus, the results were based on unadjusted estimates due to slight variations in the inclusion criteria for each individual patient.[45],[46] Second, many factors could affect the DR of 18F-PSMA PET/CT, such as reagent resources, tumor size, assay type, cutoff value, and the proficiency of a particular physician. These factors were, however, not considered in the subgroup analysis. Prospect studies should focus on exploring better diagnostic strategies for PCa. Third, there were no studies reporting on adverse events in 18F-PSMA PET/CT in all the included trials. As a result, additional exploration to determine adverse events should be prospected for and studied. In addition, the PET/CT scan may underestimate the burden of the recurrence of PCa patients with a PSA below 1.5 ng ml−1 and a limited nodal tumor load. This may be so regardless of the tracer used.[47] All of the studies included in this study were conducted in the Caucasian population and cannot be generalized to the situation among other races. Thus, future studies should consider the influence of ethnicity-related factors. Overall, this meta-analysis demonstrated a good DR of 18F-PSMA PET/CT in patients with PCa, but large prospective multicentric studies, and in particular, the influence of different factors such as ethnicity, are warranted.


  Conclusions Top


In summary, 18F-labeled PSMA PET/CT demonstrated a good DR in patients with PCa compared to those reported in the literature with 68Ga-labeled PSMA PET/CT. Based on the Gleason score, the DR of 18F-labeled PSMA PET/CT is correlated with PSA values whereby significantly lower DR is recorded in patients having PSA <0.5 ng ml−1. Prospective multicentric trials with a large sample size are needed to justify these results. Nevertheless, 18F-labeled PSMA PET/CT is significantly important in the management of PCa.


  Author Contributions Top


RPJ, ZQQ, and GJP designed the study, collected, analyzed, and interpreted the clinical data, and wrote the manuscript. GJP, ZX, LWX, and HW analyzed part of the data. RPJ and ZQQ supervised the project and revised the manuscript. All authors read and approved the final manuscript.


  Competing Interests Top


All authors declare no competing interests.


  Acknowledgments Top


This study was supported by grants from Nanjing Medical Science and Technology Development Foundation (YKK16138), Jiangsu Provincial Medical Youth Talent (QNRC2016072), and Science and Technology Development Fund of Nanjing Medical University (NMUB2018317).



 
  References Top

1.
Sung H. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209–49.  Back to cited text no. 1
    
2.
True LD, Chen DL. How accurately does PSMA inhibitor 18F-DCFPyL-PET-CT image prostate cancer? Clin Cancer Res 2021; 27: 3512–4.  Back to cited text no. 2
    
3.
Rawla P. Epidemiology of prostate cancer. World J Oncol 2019; 10: 63–89.  Back to cited text no. 3
    
4.
Murthy V. The role of PSMA PET/CT and PET/MRI in the initial staging of prostate cancer. Eur Urol Focus 2021; 7: 258–66.  Back to cited text no. 4
    
5.
Fakhrejahani F, Madan RA, Dahut WL. Management options for biochemically recurrent prostate cancer. Curr Treat Options Oncol 2017; 18: 26.  Back to cited text no. 5
    
6.
Maurer T, Eiber M, Schwaiger M, Gschwend JE. Current use of PSMA-PET in prostate cancer management. Nat Rev Urol 2016; 13: 226–35.  Back to cited text no. 6
    
7.
Abramson RG, Lakomkin N, Hainline A, Kang H, Hutson MS, et al. The attenuation distribution across the long axis of breast cancer liver metastases at CT: a quantitative biomarker for predicting overall survival. AJR Am J Roentgenol 2018; 210: W1–7.  Back to cited text no. 7
    
8.
Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic performance of magnetic resonance imaging for the management of bone metastasis in prostate cancer: a systematic review and meta-analysis. Eur Urol 2018; 73: 81–91.  Back to cited text no. 8
    
9.
van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 2019; 75: 570–8.  Back to cited text no. 9
    
10.
Sexton SJ, Lavien G, Said N, Eward W, Peterson AC, et al. Magnetic resonance imaging features of pubic symphysis urinary fistula with pubic bone osteomyelitis in the treated prostate cancer patient. Abdom Radiol (NY) 2019; 44: 1453–60.  Back to cited text no. 10
    
11.
Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C. Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 1997; 3: 81–5.  Back to cited text no. 11
    
12.
Bostwick DG, Pacelli A, Blute M, Roche P, Murphy GP. Prostate specific membrane antigen expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 184 cases. Cancer 1998; 82: 2256–61.  Back to cited text no. 12
    
13.
Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013; 40: 486–95.  Back to cited text no. 13
    
14.
Sheikhbahaei S, Afshar-Oromieh A, Eiber M, Solnes LB, Javadi MS, et al. Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging 2017; 44: 2117–36.  Back to cited text no. 14
    
15.
Backhaus P, Noto B, Avramovic N, Grubert LS, Huss S, et al. Targeting PSMA by radioligands in non-prostate disease-current status and future perspectives. Eur J Nucl Med Mol Imaging 2018; 45: 860–77.  Back to cited text no. 15
    
16.
Afshar-Oromieh A, Haberkorn U, Eder M, Eisenhut M, Zechmann CM. [68Ga]Gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: comparison with 18F-FECH. Eur J Nucl Med Mol Imaging 2012; 39: 1085–6.  Back to cited text no. 16
    
17.
Afshar-Oromieh A, Holland-Letz T, Giesel FL, Kratochwil C, Mier W, et al. Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients. Eur J Nucl Med Mol Imaging 2017; 44: 1258–68.  Back to cited text no. 17
    
18.
Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2014; 41: 11–20.  Back to cited text no. 18
    
19.
Kesch C, Kratochwil C, Mier W, Kopka K, Giesel FL. 68Ga or 18F for prostate cancer imaging? J Nucl Med 2017; 58: 687–8.  Back to cited text no. 19
    
20.
Giesel FL, Kesch C, Yun M, Cardinale J, Haberkorn U, et al. 18F-PSMA PET/CT detects micrometastases in a patient with biochemically recurrent prostate cancer. Clin Genitourin Cancer 2017; 15: e497–9.  Back to cited text no. 20
    
21.
Panagiotidis E, Paschali A, Giannoula E, Chatzipavlidou V. Rib fractures mimicking bone metastases in 18F-PSMA PET/CT for prostate cancer. Clin Nucl Med 2019; 44: e46–8.  Back to cited text no. 21
    
22.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009; 151: W65–94.  Back to cited text no. 22
    
23.
Rahbar K, Afshar-Oromieh A, Seifert R, Wagner S, Schafers M, et al. Diagnostic performance of 18F-PSMA PET/CT in patients with biochemical recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2018; 45: 2055–61.  Back to cited text no. 23
    
24.
Giesel FL, Knorr K, Spohn F, Will L, Maurer T, et al. Detection efficacy of 18F-PSMA-1007 PET/CT in 251 patients with biochemical recurrence of prostate cancer after radical prostatectomy. J Nucl Med 2019; 60: 362–8.  Back to cited text no. 24
    
25.
Rahbar K, Afshar-Oromieh A, Bogemann M, Wagner S, Schafers M, et al. 18F-PSMA PET/CT at 60 and 120 minutes in patients with prostate cancer: biodistribution, tumour management and activity kinetics. Eur J Nucl Med Mol Imaging 2018; 45: 1329–34.  Back to cited text no. 25
    
26.
Giesel FL, Will L, Kesch C, Freitag M, Kremer C, et al. Biochemical recurrence of prostate cancer: initial results with [18F]PSMA PET/CT. J Nucl Med 2018; 59: 632–5.  Back to cited text no. 26
    
27.
Giesel FL, Will L, Lawal I, Lengana T, Kratochwil C, et al. Intraindividual comparison of 18F-PSMA and 18F-DCFPyL PET/CT in the prospective evaluation of patients with newly diagnosed prostate carcinoma: a pilot study. J Nucl Med 2018; 59: 1076–80.  Back to cited text no. 27
    
28.
Kesch C, Vinsensia M, Radtke JP, Schlemmer HP, Heller M, et al. Intra-individual comparison of 18F-PSMA-PET/CT, multi-parametric MRI and radical prostatectomy specimen in patients with primary prostate cancer: a retrospective, proof of concept study. J Nucl Med 2017; 58: 1805–10.  Back to cited text no. 28
    
29.
Wondergem M, van der Zant FM, Knol R, Lazarenko SV, Pruim J, et al. 18F-DCFPyL PET/CT in the detection of prostate cancer at 60 and 120 minutes: detection rate, image quality, activity kinetics, and biodistribution. J Nucl Med 2017; 58: 1797–804.  Back to cited text no. 29
    
30.
Mena E, Lindenberg ML, Shih JH, Adler S, Harmon S, et al. Clinical impact of PSMA-based 18F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. Eur J Nucl Med Mol Imaging 2018; 45: 4–11.  Back to cited text no. 30
    
31.
Rousseau E, Wilson D, Lacroix-Poisson F, Krauze A, Chi K, et al. A prospective study on (18)F-DCFPyL PSMA PET/CT imaging in biochemical recurrence of prostate cancer. J Nucl Med 2019; 60: 1587–93.  Back to cited text no. 31
    
32.
Dietlein F, Hohberg M, Kobe C, Zlatopolskiy BD, Krapf P, et al. An 18F-labeled PSMA ligand for PET/CT of prostate cancer: first-in-humans observational study and clinical experience with 18F-JK-PSMA-7 during the first year of application. J Nucl Med 2020; 61: 202–9.  Back to cited text no. 32
    
33.
Rauscher I, Kronke M, Konig M, Gafita A, Maurer T, et al. Matched-pair comparison of 68Ga-PSMA-11 PET/CT and 18F-PSMA-1007 PET/CT: frequency of pitfalls and detection efficacy in biochemical recurrence after radical prostatectomy. J Nucl Med 2020; 61: 51–7.  Back to cited text no. 33
    
34.
Rowe SP, Li X, Trock BJ, Werner RA, Frey S, et al. Prospective comparison of PET imaging with PSMA-targeted 18F-DCFPyL versus Na18F for bone lesion detection in patients with metastatic prostate cancer. J Nucl Med 2020; 61: 183–8.  Back to cited text no. 34
    
35.
Dietlein F, Kobe C, Hohberg M, Zlatopolskiy BD, Krapf P, et al. Intraindividual comparison of 18F-PSMA-1007 with renally excreted PSMA ligands for PSMA PET imaging in patients with relapsed prostate cancer. J Nucl Med 2020; 61: 729–34.  Back to cited text no. 35
    
36.
Kuten J, Fahoum I, Savin Z, Shamni O, Gitstein G, et al. Head-to-head comparison of 68Ga-PSMA-11 with 18F-PSMA-1007 PET/CT in staging prostate cancer using histopathology and immunohistochemical analysis as a reference standard. J Nucl Med 2020; 61: 527–32.  Back to cited text no. 36
    
37.
Witkowska-Patena E, Gizewska A, Dziuk M, Misko J, Budzynska A, et al. Diagnostic performance of 18F-PSMA-1007 PET/CT in biochemically relapsed patients with prostate cancer with PSA levels ≤ 2.0 ng/ml. Prostate Cancer Prostatic Dis 2020; 23: 343–8.  Back to cited text no. 37
    
38.
Sachpekidis C, Afshar-Oromieh A, Kopka K, Strauss DS, Pan L, et al. 18F-PSMA-1007 multiparametric, dynamic PET/CT in biochemical relapse and progression of prostate cancer. Eur J Nucl Med Mol Imaging 2020; 47: 592–602.  Back to cited text no. 38
    
39.
Mulhem E, Fulbright N, Duncan N. Prostate cancer screening. Am Fam Physician 2015; 92: 683–8.  Back to cited text no. 39
    
40.
Pepe P, Garufi A, Priolo G, Pennisi M. Transperineal versus transrectal MRI/TRUS fusion targeted biopsy: management rate of clinically significant prostate cancer. Clin Genitourin Cancer 2017; 15: e33–6.  Back to cited text no. 40
    
41.
Tabayoyong W, Abouassaly R. Prostate cancer screening and the associated controversy. Surg Clin North Am 2015; 95: 1023–39.  Back to cited text no. 41
    
42.
Rischke HC, Eiberger AK, Volegova-Neher N, Henne K, Krauss T, et al. PET/CT and MRI directed extended salvage radiotherapy in recurrent prostate cancer with lymph node metastases. Adv Med Sci 2016; 61: 212–8.  Back to cited text no. 42
    
43.
Gordon LG, Elliott TM, Joshi A, Williams ED, Vela I. Exploratory cost-effectiveness analysis of 68Gallium-PSMA PET/MRI-based imaging in patients with biochemical recurrence of prostate cancer. Clin Exp Metastasis 2020; 37: 305–12.  Back to cited text no. 43
    
44.
Treglia G, Annunziata S, Pizzuto DA, Giovanella L, Prior JO, et al. Detection rate of 18F-labeled PSMA PET/CT in biochemical recurrent prostate cancer: a systematic review and a meta-analysis. Cancers (Basel) 2019; 11: 710.  Back to cited text no. 44
    
45.
Dhariwal A, Chong J, Habib S, King IL, Agellon LB, et al. MicrobiomeAnalyst: a web-based tool for comprehensive statistical, visual and meta-analysis of microbiome data. Nucleic Acids Res 2017; 45: W180–8.  Back to cited text no. 45
    
46.
Adamcik M. A logician's approach to meta-analysis with unexplained heterogeneity. J Biomed Inform 2017; 71: 110–29.  Back to cited text no. 46
    
47.
Fossati N. Underestimation of positron emission tomography/computerized tomography in assessing tumor burden in prostate cancer nodal recurrence: head-to-head comparison of 68Ga-PSMA and 11C-choline in a large, multi-institutional series of extended salvage lymph node dissections. J Urol 2020; 204: 296–302.  Back to cited text no. 47
    
48.
Rowe SP, Campbell SP, Mana-Ay M, Szabo Z, Alla ME, et al. Prospective evaluation of PSMA-targeted 18F-DCFPyL PET/CT in men with biochemical failure after radical prostatectomy for prostate cancer. J Nucl Med 2020; 61: 58-61.  Back to cited text no. 48
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

 
Top
 
 
  Search
 
 Search Pubmed for
 
    -  Qin ZQ
    -  Pan GJ
    -  Xu Z
    -  Wang H
    -  Xu LW
    -  Jia RP
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
Author Contributions
Competing Interests
Acknowledgments
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed530    
    PDF Downloaded36    

Recommend this journal