PET/MRI in prostate cancer: a systematic review and meta-analysis

Abstract

Aim In recent years, the clinical availability of scanners for integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) has enabled the practical potential of multimodal, combined metabolic-receptor, anatomical, and functional imaging to be explored. The present systematic review and meta-analysis summarize the diagnostic information provided by PET/MRI in patients with prostate cancer (PCa). Materials and methods A literature search was conducted in three different databases. The terms used were “choline” or “prostate-specific membrane antigen - PSMA” AND “prostate cancer” or “prostate” AND “PET/MRI” or “PET MRI” or “PET-MRI” or “positron emission tomography/magnetic resonance imaging.” All relevant records identified were combined, and the full texts were retrieved. Reports were excluded if (1) they did not consider hybrid PET/MRI; or (2) the sample size was < 10 patients; or (3) the raw data were not enough to enable the completion of a 2 × 2 contingency table. Results Fifty articles were eligible for systematic review, and 23 for meta-analysis. The pooled data concerned 2104 patients. Initial disease staging was the main indication for PET/MRI in 24 studies. Radiolabeled PSMA was the tracer most frequently used. In primary tumors, the pooled sensitivity for the patient-based analysis was 94.9%. At restaging, the pooled detection rate was 80.9% and was higher for radiolabeled PSMA than for choline (81.8% and 77.3%, respectively). Conclusions PET/MRI proved highly sensitive in detecting primary PCa, with a high detection rate for recurrent disease, particularly when radiolabeled PSMA was used.

Prospective analysis of clinically significant prostate cancer detection with [18F]DCFPyL PET/MRI compared to multiparametric MRI: a comparison with the histopathology in the radical prostatectomy specimen, the ProStaPET study

“…The ability of both [ 18 F]DCFPyL PET/MRI and mpMRI to detect locally advanced disease was low with sensitivities of 35.29% and 41.18%, respectively. This under-staging for mpMRI and [ 18 F]DCFPyL PET/MRI is in line with previous reports [17,31]. One retrospective study by Muehlematter et al on 40 consecutive patients receiving both [ 68 Ga]Ga-PSMA-11 PET/MRI and mpMRI prior to RARP reported on a patientspecific sensitivity of detecting locally advanced disease of 69% vs. 46% (p = 0.04) and a specificity of 67% and 75% (p = 0.19) [15].…”

“…Additionally, PSMA-PET/MRI enables wholebody staging at a lower radiation dose, and can guide prostate biopsies in a single hospital visit, which is advantageous over performing both a pre-biopsy mpMRI and a staging PSMA PET/CT. This is the largest prospective study investigating the value of PSMA-PET using [ 18 F]DCFPyL combined with MRI compared to that of mpMRI alone [16,17]. In this, we compared tumour localization and local tumour staging of both imaging modalities to the gold standard, i.e., tumour localization and tumour stage determined in the radical prostatectomy specimen.…”

MRI/PET Imaging in elevated PSA and localized prostate cancer: a narrative review

“…Multi parametric MRI clearly stands out on the basis of strong evidence for pre biopsy evaluation and the role of PSMA PET/CT as a staging modality in localized prostate cancer is rising. The advantage of PET/MRI lies in the fact that it combines two of these excellent imaging modalities and MRI offers better soft tissue definition than CT. Areas where we could see its emerging role would be in oligometastatic disease and high-risk disease where the ability to identify more lesions would have a significant impact on the treatment approach (83). PET/MRI, therefore, has promising implications in the diagnosis and staging of prostate cancer but needs further validation in terms of research and logistics to be of primetime use.…”

Comparison of MRI, PET, and 18F-choline PET/MRI in patients with oligometastatic recurrent prostate cancer

“…In PCa, PET/MR can be performed by diverse radiopharmaceutical agents [25,26]. A recent meta-analysis showed that PSMA PET/MR has a higher pooled detection rate for the identification of biochemical recurrence as compared to Choline PET/MR (81.8% vs. 77.3%, respectively), independently from the PSA range [26].…”

“…In PCa, PET/MR can be performed by diverse radiopharmaceutical agents [25,26]. A recent meta-analysis showed that PSMA PET/MR has a higher pooled detection rate for the identification of biochemical recurrence as compared to Choline PET/MR (81.8% vs. 77.3%, respectively), independently from the PSA range [26]. However, the highest difference in detection rate, between 18F-Choline and 68 Ga-PSMA PET/MR, was found for PSA level < 1 ng/mL (42.86% vs. 75%, respectively) [2,27].…”