Diagnostic Performance of Radiolabeled Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging in Newly Diagnosed Intermediate to High-Risk Prostate Cancer Patients: A Systematic Review and Meta-Analysis

Introduction: We aimed to assess the diagnostic accuracy of radiolabeled prostate-specific membrane antigen positron emission tomography (PSMA PET) or positron emission tomography/computed tomography (PET/CT) for primary lymph node (LN) staging in newly diagnosed intermediate to high-risk prostate cancer (PCa) patients. Material and Methods: The MEDLINE, PubMed, EMBASE, and Cochrane Library database from the earliest available date of indexing through May 31, 2018, were searched for studies evaluating the diagnostic performance of radiolabeled PSMA PET or PET/CT for primary LN staging in newly diagnosed intermediate to high-risk PCa. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), and constructed summary receiver operating characteristic curves. Results: Across 6 studies (298 patients), the pooled sensitivity was 0.71 (95% CI 0.59–0.81) and a pooled specificity of 0.95 (95% CI 0.87–0.99). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 15.6 (95% CI 5.6–43.0) and negative likelihood ratio (LR–) of 0.30 (95% CI 0.21–0.43). The pooled diagnostic odds ratio (DOR) was 51 (95% CI 21–126). Conclusion: Radiolabeled PSMA PET/CT shows a moderate sensitivity and high specificity for the detection of metastatic LNs in patients with newly diagnosed intermediate to high-risk PCa.