TY - JOUR
T1 - PSMA-targeted radiotracers versus 18F fluciclovine for the detection of prostate cancer biochemical recurrence after definitive therapy
T2 - A systematic review and meta-analysis
AU - Tan, Nelly
AU - Oyoyo, Udochukwu
AU - Bavadian, Niusha
AU - Ferguson, Nicholas
AU - Mukkamala, Anudeep
AU - Calais, Jeremie
AU - Davenport, Matthew S.
N1 - Publisher Copyright:
© RSNA, 2020.
PY - 2020/7
Y1 - 2020/7
N2 - Background: National guidelines endorse fluorine 18 (18F) fluciclovine PET/CT for the detection of prostate cancer (PCa) in men with biochemically recurrent PCa. The comparative performance between fluciclovine and gallium 68 or 18F prostate-specific membrane antigen (PSMA) PET/CT, a newer examination, is unclear. Purpose: To compare the detection of biochemical recurrence using fluciclovine versus PSMA-targeted radiotracers in patients with a prostate-specific antigen (PSA) level less than 2 ng/mL. Materials and Methods: With use of the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy, or PRISMA-DTA, guidelines, a systematic review of PubMed and EMBASE databases between 2012 and 2019 was performed. Studies of fluciclovine PET/CT or PSMA PET/CT in biochemical recurrence were identified. PSA levels, clinical data, and reference standards were obtained when available. A random-effects model was applied to pooled estimates and 95% confidence intervals (CIs) around the prevalence of a positive examination, stratified according to PSA tier. Results: Quantitative analysis included 482 patients (median age, 67 years; interquartile range, 67–67 years) in six fluciclovine studies and 3217 patients (median age, 68 years; interquartile range, 67–70 years) in 38 PSMA studies. Pooled detection rates for PSMA and fluciclovine were 45% (95% CI: 38%, 52%) and 37% (95% CI: 25%, 49%), respectively, for a PSA level less than 0.5 ng/mL (P = .46); 59% (95% CI: 52%, 66%) and 48% (95% CI: 34%, 61%) for a PSA level of 0.5–0.9 ng/mL (P = .19); and 80% (95% CI: 75%, 85%) and 62% (95% CI: 54%, 70%) for a PSA level of 1.0–1.9 ng/mL (P = .01). A reference standard was positive in 703 of 735 patients (96%) in the PSMA cohort and 247of 256 (97%) in the fluciclovine cohort. Conclusion: Patient-level detection rates for biochemically recurrent prostate cancer were greater for prostate-specific membrane antigen–targeted radiotracers than fluciclovine for prostate specific antigen levels of 1.0–1.9 ng/mL.
AB - Background: National guidelines endorse fluorine 18 (18F) fluciclovine PET/CT for the detection of prostate cancer (PCa) in men with biochemically recurrent PCa. The comparative performance between fluciclovine and gallium 68 or 18F prostate-specific membrane antigen (PSMA) PET/CT, a newer examination, is unclear. Purpose: To compare the detection of biochemical recurrence using fluciclovine versus PSMA-targeted radiotracers in patients with a prostate-specific antigen (PSA) level less than 2 ng/mL. Materials and Methods: With use of the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy, or PRISMA-DTA, guidelines, a systematic review of PubMed and EMBASE databases between 2012 and 2019 was performed. Studies of fluciclovine PET/CT or PSMA PET/CT in biochemical recurrence were identified. PSA levels, clinical data, and reference standards were obtained when available. A random-effects model was applied to pooled estimates and 95% confidence intervals (CIs) around the prevalence of a positive examination, stratified according to PSA tier. Results: Quantitative analysis included 482 patients (median age, 67 years; interquartile range, 67–67 years) in six fluciclovine studies and 3217 patients (median age, 68 years; interquartile range, 67–70 years) in 38 PSMA studies. Pooled detection rates for PSMA and fluciclovine were 45% (95% CI: 38%, 52%) and 37% (95% CI: 25%, 49%), respectively, for a PSA level less than 0.5 ng/mL (P = .46); 59% (95% CI: 52%, 66%) and 48% (95% CI: 34%, 61%) for a PSA level of 0.5–0.9 ng/mL (P = .19); and 80% (95% CI: 75%, 85%) and 62% (95% CI: 54%, 70%) for a PSA level of 1.0–1.9 ng/mL (P = .01). A reference standard was positive in 703 of 735 patients (96%) in the PSMA cohort and 247of 256 (97%) in the fluciclovine cohort. Conclusion: Patient-level detection rates for biochemically recurrent prostate cancer were greater for prostate-specific membrane antigen–targeted radiotracers than fluciclovine for prostate specific antigen levels of 1.0–1.9 ng/mL.
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U2 - 10.1148/radiol.2020191689
DO - 10.1148/radiol.2020191689
M3 - Article
C2 - 32396045
SN - 0033-8419
VL - 296
SP - 44
EP - 55
JO - Radiology
JF - Radiology
IS - 1
ER -