Comparison of Multiparametric Magnetic Resonance Imaging with Prostate-Specific Membrane Antigen Positron-Emission Tomography Imaging in Primary Prostate Cancer Diagnosis: A Systematic Review and Meta-Analysis

Abstract

Multiparametric magnetic-resonance imaging (mpMRI) has proven utility in diagnosing primary prostate cancer. However, the diagnostic potential of prostate-specific membrane antigen positron-emission tomography (PSMA PET) has yet to be established. This study aims to systematically review the current literature comparing the diagnostic performance of mpMRI and PSMA PET imaging to diagnose primary prostate cancer. A systematic literature search was performed up to December 2021. Quality analyses were conducted using the QUADAS-2 tool. The reference standard was whole-mount prostatectomy or prostate biopsy. Statistical analysis involved the pooling of the reported diagnostic performances of each modality, and differences in per-patient and per-lesion analysis were compared using a Fisher’s exact test. Ten articles were included in the meta-analysis. At a per-patient level, the pooled values of sensitivity, specificity, and area under the curve (AUC) for mpMRI and PSMA PET/CT were 0.87 (95% CI: 0.83–0.91) vs. 0.93 (95% CI: 0.90–0.96, p < 0.01); 0.47 (95% CI: 0.23–0.71) vs. 0.54 (95% CI: 0.23–0.84, p > 0.05); and 0.84 vs. 0.91, respectively. At a per-lesion level, the pooled sensitivity, specificity, and AUC value for mpMRI and PSMA PET/CT were lower, at 0.63 (95% CI: 0.52–0.74) vs. 0.79 (95% CI: 0.62–0.92, p < 0.001); 0.88 (95% CI: 0.81–0.95) vs. 0.71 (95% CI: 0.47–0.90, p < 0.05); and 0.83 vs. 0.84, respectively. High heterogeneity was observed between studies. PSMA PET/CT may better confirm the presence of prostate cancer than mpMRI. However, both modalities appear comparable in determining the localisation of the lesions.

Detecting localised prostate cancer using radiomic features in PSMA PET and multiparametric MRI for biologically targeted radiation therapy

“…Results showed that an RFC model for detecting prostate cancer using combined PET and mpMRI radiomic features performed better than RFC models developed using radiomic features from either modality alone. This was not unexpected, due to the aforementioned complementary nature of the imaging modalities as demonstrated in many non-radiomics studies and clinical trials [ 9 , 33 – 35 ]. This result was also consistent with studies by Zamboglou et al [ 36 ] and Spohn et al [ 37 ] who did not utilise radiomics, but similarly validated imaging with ground truth pathology data and showed that PSMA PET is a valuable addition alongside mpMRI for defining the gross tumour volumes (GTV) for focal therapy applications, where mpMRI is more likely to underestimate tumour volume than PSMA PET [ 36 , 37 ].…”

The Role of [68Ga]PSMA PET/CT for Clinical Suspicion of Prostate Cancer in Patients with or without Previous Negative Biopsy: A Systematic Review

“…Finally, the AUC of summed ROC curves was 0.91 (95% CI: 0.88–0.93). In a more recent meta-analysis by Zhao et al [ 49 ], PSMA PET/CT outperformed MRI for detecting primary PCa, with a pooled sensitivity of 0.93 vs. 0.87 ( p < 0.01). On the other hand, both techniques were similar for the localization of the lesions.…”

PSMA-Targeted Radiopharmaceuticals for Prostate Cancer Diagnosis and Therapy

“…PSMA PET (MR or CT) is more sensitive and specific for primary tumor detection and lymph node staging (90/84% vs. 66/60% for primary, 91/90% vs. 68/46% for nodes), whereas mpMRI has better accuracy for extracapsular extension (79/76% vs. 59/66%) and seminal vesicle infiltration (93/96% vs. 51/60%) 24 . Further meta-analyses show PET is better than MRI alone, 25 but PET and MRI together are better than PET alone 26 . Overall, then, MRI's superior soft tissue contrast and spatial resolution can help find extracapsular extension and seminal vesicle infiltration, and PET's contrast resolution aids its ability to find small or subtle intraprostatic lesions and nodal metastases, and the modalities are likely best used together.…”