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  • Review Article
  • Clinical Research
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The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases volume 26, pages 240–248 (2023)Cite this article

Subjects

Abstract

Background

Prostate-specific membrane antigen (PSMA) PET is highly sensitive in identifying disease recurrence in men with biochemical recurrence of prostate cancer (BCR) after primary therapy and is rapidly being adopted in clinical practice. The purpose of this systematic review and meta-analysis was to assess the documented impact of PSMA-PET on patient management and outcomes, including prostate-specific antigen (PSA) response, and intermediate and long-term outcome measures.

Materials and methods

MBASE, PubMed, Web of Science, Cochrane and OVID databases were searched for studies reporting on the impact of PSMA-PET on the management and outcomes of patients with BCR after definitive primary therapy. Outcome measures assessed included biochemical response to therapy after PET and BCR-free survival (BRFS). The proportions of patients in whom management changed, and the proportion of patients in whom each outcome measure was obtained were tabulated and pooled into meta-analysis using DerSimonian-Laird method.

Results

A total of 34 studies with 3680 men reported change in management after PSMA-PET and 27 studies with 2639 men reported on at least one outcome measure and had follow-up data. PSMA-PET was positive in 2508/3680 (68.2%). The pooled proportion of change in management after PSMA-PET was 56.4% (95% CI, 48.0–63.9%). A decrease in serum PSA was documented in 72.4% of men (95% CI, 63.4–81.5%), and complete biochemical response in 23.3% (95% CI, 14.6–32.0%) at a median follow-up of 8.1 and 11 months, respectively. The pooled BRFS rate was 60.2% (95% CI, 49.1–71.4%) at a median follow-up of 20 months.

Conclusion

In conclusion, PSMA PET is positive in more than 2/3 of men with BCR and impacts patient management in more than half of the men. BRFS after PET-directed management is 60% at a median of 20 months after salvage therapy, and complete biochemical response may be achieved in up to a quarter of men.

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Fig. 1: PRISMA flowchart for study selection process.
Fig. 2: Forest plot of pooled proportion of management changes after PSMA PET.
Fig. 3: Forest plot of pooled proportion of therapy response.
Fig. 4: Forest plot of biochemical relapse-free survival rate proportion meta-analysis in patients treated with PSMA PET-guided MDT without androgen deprivation therapy.

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Data availability

The datasets used and/or analyzed during this study are available from the authors (AP, RK, UM) by request.

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Author notes

  1. These authors contributed equally: Alex Pozdnyakov, Roshini Kulanthaivelu.

Authors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Alex Pozdnyakov

  2. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women’s College Hospital; University of Toronto, Toronto, ON, Canada

    Roshini Kulanthaivelu, Claudia Ortega, Patrick Veit-Haibach & Ur Metser

  3. Department of Oncology, Western University, London, ON, Canada

    Glenn Bauman

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AP and RK listed in this manuscript had led the study design, data extraction, and analysis, and their contributions to this study were equal. All authors read and approved the final manuscript.

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Correspondence to Ur Metser.

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As this is a systematic review, institutional review board or patient consent were not required. The protocol for this study was registered in PROSPERO (The international Prospective Register of Systematic Reviews) with registration number CRD42020212541. As for all systematic reviews and meta-analyses, the patients presented in this meta-analysis have been previously reported.

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Pozdnyakov, A., Kulanthaivelu, R., Bauman, G. et al. The impact of PSMA PET on the treatment and outcomes of men with biochemical recurrence of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 26, 240–248 (2023). https://doi.org/10.1038/s41391-022-00544-3

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