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Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

Authors
  • Luiting, Henk B.1
  • van Leeuwen, Pim J.2
  • Busstra, Martijn B.1
  • Brabander, Tessa1
  • van der Poel, Henk G.2
  • Donswijk, Maarten L.2
  • Vis, André N.3
  • Emmett, Louise4, 5
  • Stricker, Phillip D.6, 7, 8
  • Roobol, Monique J.1
  • 1 Erasmus University Medical Centre, The Netherlands , (Netherlands)
  • 2 Netherlands Cancer Institute, The Netherlands , (Netherlands)
  • 3 Amsterdam UMC, Location VUmc, The Netherlands , (Netherlands)
  • 4 St Vincent's Hospital, Australia , (Australia)
  • 5 University of New South Wales, Australia , (Australia)
  • 6 St. Vincent's Prostate Cancer Centre, Australia , (Australia)
  • 7 Kinghorn Cancer Centre, Australia , (Australia)
  • 8 UNSW, Australia , (Australia)
Type
Published Article
Journal
British Journal of Urology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Nov 29, 2019
Volume
125
Issue
2
Pages
206–214
Identifiers
DOI: 10.1111/bju.14944
PMID: 31680398
PMCID: PMC7383738
Source
PubMed Central
Keywords
License
Unknown
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Abstract

Objectives To review the literature to determine the sensitivity and specificity of gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68Ga‐PSMA PET in patients with BCR after radical prostatectomy (RP). Materials and Methods We performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were ‘(PSMA, 68Ga‐PSMA, 68Gallium‐PSMA, Ga‐68‐PSMA or prostate‐specific membrane antigen)’ and ‘(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)’. Relevant abstracts were reviewed and full‐text articles obtained where possible. References to and from obtained articles were searched to identify further relevant articles. Results Nine retrospective and two prospective studies described the sensitivity and specificity of 68Ga‐PSMA PET for detecting pelvic lymph node metastases before initial treatment, which ranged from 33.3% to 100% and 80% to 100%, respectively. In eight retrospective studies, the positive predictive value of 68Ga‐PSMA PET in patients with BCR before salvage lymph node dissection ranged from 70% to 100%. The detection rate of 68Ga‐PSMA PET in patients with BCR after RP in the PSA subgroups <0.2 ng/mL, 0.2–0.49 ng/mL and 0.5 to <1.0 ng/mL ranged from 11.3% to 50.0%, 20.0% to 72.7% and 25.0% to 87.5%, respectively. Conclusion The review results showed that 68Ga‐PSMA PET had a high specificity for the detection of pelvic lymph node metastases in primary PCa. Furthermore, 68Ga‐PSMA PET had a very high positive predictive value in detecting lymph node metastases in patients with BCR. By contrast, sensitivity was only moderate; therefore, based on the currently available literature, 68Ga‐PSMA PET cannot yet replace pelvic lymph node dissection to exclude lymph node metastases. In the salvage phase, 68Ga‐PSMA PET had both a high detection rate and impact on radiotherapy planning in early BCR after RP.

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