Article type
Abstract
Background:
Prostate-specific membrane antigen (PSMA)-targeted radiotracers are increasingly being applied in clinical practice in an attempt to improve the diagnostic accuracy of staging and restaging; however recommendations on their use (and the strength of those recommendations) vary.
Objectives: To consolidate existing evidence syntheses and provide a comprehensive overview of the evidence for 18F-PSMA PET/CT in the staging of high-risk prostate cancer, intermediate/high-risk prostate cancer and re-staging after biochemical recurrence.
Methods:
An overview of reviews was performed and reported in line with the preferred reporting items for overview of reviews (PRIOR) statement and synthesis without meta-analysis (SWiM) reporting guidelines. A comprehensive database and grey literature search was conducted up to 18 July 2023. Systematic reviews were assessed using the risk of bias in systematic reviews (ROBIS) tool. The certainty of the evidence was assessed using grading of recommendations, assessment, development and evaluations (GRADE). Data on intermediate/high-risk groups which could not be disaggregated were extracted, and considered relative to the data from solely high-risk groups.
Results:
Eleven systematic reviews were identified, 10 of which were at high or unclear risk of bias. Sensitivity, specificity and overall accuracy were reported on a per-patient, per-lymph node and per-lesion basis. There was a lack of data on dose, adverse events and evidence comparing 18F-PSMA PET/CT to other imaging modalities. Evidence with moderate to very low certainty indicated high sensitivity, specificity and accuracy of 18F-PSMA PET/CT in patients with high-risk prostate cancer and biochemical recurrence. For the combined intermediate/high-risk cohort, there was greater variability in effect estimates and evidence for the outcomes was of lower certainty.
Conclusion:
While evidence gaps remain for some outcomes, and most systematic reviews were at high or unclear risk of bias, the current evidence base is broadly supportive of 18F-PSMA PET/CT imaging in the staging and restaging of patients with high-risk prostate cancer and biochemical recurrence.
Statement on the relevance and importance:
Although evidence gaps remain, 18F-PSMA PET/CT is generally associated with high diagnostic accuracy when staging patients with high-risk prostate cancer or biochemical recurrence. However, effect estimates vary greatly and are of lower certainty in patients with intermediate/high-risk prostate cancer.
Prostate-specific membrane antigen (PSMA)-targeted radiotracers are increasingly being applied in clinical practice in an attempt to improve the diagnostic accuracy of staging and restaging; however recommendations on their use (and the strength of those recommendations) vary.
Objectives: To consolidate existing evidence syntheses and provide a comprehensive overview of the evidence for 18F-PSMA PET/CT in the staging of high-risk prostate cancer, intermediate/high-risk prostate cancer and re-staging after biochemical recurrence.
Methods:
An overview of reviews was performed and reported in line with the preferred reporting items for overview of reviews (PRIOR) statement and synthesis without meta-analysis (SWiM) reporting guidelines. A comprehensive database and grey literature search was conducted up to 18 July 2023. Systematic reviews were assessed using the risk of bias in systematic reviews (ROBIS) tool. The certainty of the evidence was assessed using grading of recommendations, assessment, development and evaluations (GRADE). Data on intermediate/high-risk groups which could not be disaggregated were extracted, and considered relative to the data from solely high-risk groups.
Results:
Eleven systematic reviews were identified, 10 of which were at high or unclear risk of bias. Sensitivity, specificity and overall accuracy were reported on a per-patient, per-lymph node and per-lesion basis. There was a lack of data on dose, adverse events and evidence comparing 18F-PSMA PET/CT to other imaging modalities. Evidence with moderate to very low certainty indicated high sensitivity, specificity and accuracy of 18F-PSMA PET/CT in patients with high-risk prostate cancer and biochemical recurrence. For the combined intermediate/high-risk cohort, there was greater variability in effect estimates and evidence for the outcomes was of lower certainty.
Conclusion:
While evidence gaps remain for some outcomes, and most systematic reviews were at high or unclear risk of bias, the current evidence base is broadly supportive of 18F-PSMA PET/CT imaging in the staging and restaging of patients with high-risk prostate cancer and biochemical recurrence.
Statement on the relevance and importance:
Although evidence gaps remain, 18F-PSMA PET/CT is generally associated with high diagnostic accuracy when staging patients with high-risk prostate cancer or biochemical recurrence. However, effect estimates vary greatly and are of lower certainty in patients with intermediate/high-risk prostate cancer.