PSMA-targeted PET imaging for brain metastases from non-prostatic solid tumors: a systematic review

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• Prostate-Specific Membrane Antigen (PSMA) is expressed in various solid tumors' neovasculature.
• PSMA PET imaging is emerging as a promising tool for detecting brain metastases (BMs) from non-prostatic cancers.
• Conventional imaging modalities have limitations in diagnosing BMs from non-prostatic origins.

Purpose of the Study:

• To systematically review the diagnostic performance of PSMA-targeted radiopharmaceuticals in imaging BMs from non-prostatic cancers.
• To compare PSMA PET's efficacy against conventional imaging techniques.
• To explore the potential theranostic applications of PSMA PET in neuro-oncology.

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Inclusion of studies evaluating diagnostic accuracy of PSMA PET for BMs from non-prostatic solid tumors.
• Assessment of methodological quality using QUADAS-2 tool and qualitative data synthesis.

Main Results:

• 23 studies analyzed 77 BMs from diverse primary malignancies.
• PSMA PET demonstrated superior detection of BMs with high tumor-to-background ratios compared to MRI and [18F]FDG PET.
• PSMA PET effectively differentiated radionecrosis from tumor recurrence and showed higher sensitivity for thyroid metastases.

Conclusions:

• PSMA PET imaging holds significant promise for improved diagnosis and management of BMs from non-prostatic cancers.
• Theranostic applications of PSMA PET are underexplored but suggest potential for personalized neuro-oncology.
• Future research should standardize protocols, explore diverse tumor subtypes, and validate clinical utility.