Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer

Abstract

Purpose Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68Ga-PSMA-11, 18F-DCFPyL, and 18F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors. Methods This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools. Results Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83–0.86), 0.61 (95% CI, 0.39–0.79), and 0.62 (95% CI, 0.46–0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78–0.89), 0.67 (95% CI, 0.52–0.80), and 0.60 (95% CI, 0.45–0.73), respectively, without significant differences (P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03–1.17; P < 0.01). Conclusions This meta-analysis found that whereas 18F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.