Context

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 ⁶⁸Ga-PSMA PET in this setting.

Objective

To perform a systematic review and meta-analysis to update reported predictors of positive ⁶⁸Ga-PSMA PET according to prior therapy and proportion of positivity in various anatomical locations with sensitivity and specificity profiles.

Evidence acquisition

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.

Evidence synthesis

A total of 37 articles including 4790 patients were analysed. For patients with biochemical recurrence, positive ⁶⁸Ga-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 ≥2 ng/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.

Conclusions

Ga-68-PSMA PET improves detection of metastases with biochemical recurrence, particularly at low pre-PET PSA levels of >0.2 ng/ml (33%) and 0.2–0.5 ng/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.

Patient summary

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.

中文翻译：

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晚期前列腺癌中68镓的前列腺特异性膜抗原正电子发射断层显像-更新的诊断实用性，敏感性，特异性和前列腺特异性膜抗原-avid病灶的分布：系统评价和荟萃分析

语境

在指导局部和全身治疗中，对高危局限性，晚期和转移性前列腺癌的准确分期变得越来越重要。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负担，通常用于生化复发或晚期疾病。在我们之前的荟萃分析之后，已经报道了一系列高产量的产品，突显了⁶⁸ Ga-PSMA PET在这种情况下的实用性。

客观的

为了进行系统的回顾和荟萃分析，以根据先前的治疗方法以及敏感性和特异性的不同解剖位置的阳性比例，更新已报道的⁶⁸ Ga-PSMA PET阳性阳性预测因子。

取证

我们根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，于2018年7月对MEDLINE，EMBASE，ScienceDirect，Cochrane图书馆和Web of Science数据库进行了严格的审查。使用质量评估（诊断准确性研究-2）工具进行质量评估。使用随机效应模型进行比例的荟萃分析。汇总敏感性和特异性值是通过拟合二元层次回归模型获得的。

证据综合

共分析了37篇文章，包括4790例患者。对于具有生化复发的患者，随着较高的PET前前列腺特异性抗原（PSA）水平，阳性⁶⁸ Ga-PSMA PET扫描也增加。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％。在格里森和≤7和≥8之间，没有发现阳性的显着差异。前列腺癌根治术（22％）和放疗（52％）患者之间在前列腺床上生化复发后的阳性率存在显着差异。在每个节点的分析中，观察到高灵敏度（75％）和特异性（99％）。

结论

Ga-68-PSMA PET可改善生化复发的转移检测，尤其是在PET前PSA含量低至> 0.2 ng / ml（33％）和0.2–0.5 ng / ml（45％）的情况下。Ga-68-PSMA-PET在汇总数据的荟萃分析中产生有利的敏感性和特异性。该分析强调了在主要和生化复发环境中，根据PSMA PET的转移扩散的不同解剖模式。

病人总结

镓68前列腺特异性膜抗原正电子发射断层扫描是一项成熟的成像技术，已针对护理标准成像方式的不足而开发，以改善对前列腺癌转移性疾病的检测，尤其是在疾病复发的情况下。迄今为止，由于缺乏数据，这种在主要分期设置中的成像方式尚存争议。鉴于越来越多的证据，我们总结了迄今为止的数据，以为临床医生提供这种成像方式的概述。