PSMA PET vs. mpMRI for Lymph Node Metastasis of Prostate Cancer: A Systematic Review and Head-to-Head Comparative Meta-analysis

To compare prostate-specific membrane antigen (PSMA) PET with multiparametric MRI (mpMRI) in the diagnosis of lymph node metastasis (LNM) in prostate cancer.

A comprehensive search of PubMed, Embase, and Web of Science identified studies published up to August 24, 2024. Studies comparing PSMA PET and mpMRI accuracy in detecting LNM in prostate cancer were included. The quality of each study was assessed using the Quality Assessment of Diagnostic Performance Studies-2 tool.

This study included 23 articles with a total of 3041 patients. The pooled analysis showed PSMA PET had a sensitivity of 0.74 (95% CI:0.62-0.85) and specificity of 0.96 (95% CI:0.93-0.98) for detecting prostate cancer LNM, while mpMRI had a sensitivity of 0.45 (95% CI:0.32-0.57) and specificity at 0.92 (95% CI:0.86-0.97). PSMA PET shows notably higher sensitivity than mpMRI, (P < 0.01) with no significant difference in specificity (P = 0.18). For initial staging, PSMA PET shows significantly higher sensitivity than mpMRI (P < 0.01), with no significant specificity difference (P = 0.17). Subgroup analysis showed that both [⁶⁸Ga]Ga-PSMA-11 PET and [¹⁸F]F-PSMA-1007 PET had higher sensitivity than mpMRI (P = 0.03, P < 0.01) without significant differences in specificity (P = 0.10, P = 0.73). Meanwhile, there was no significant difference in the sensitivity (P = 0.20) and specificity (P = 0.43) of [¹⁸F]F-DCFPyL PET.

PSMA PET is more sensitive than mpMRI in detecting LNM in prostate cancer, especially for initial staging; however, there is no significant difference in specificity between the two. Due to the high heterogeneity, more subgroup-based studies are needed to standardize imaging practices and validate these findings.