Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions

Jiafu Wang; Yue Han; Lin Lin; Linhan Zhang; Jin Li; Huiqi Gao; Peng Fu

doi:10.21037/tau-21-912

Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions

Transl Androl Urol. 2021 Nov;10(11):4231-4240. doi: 10.21037/tau-21-912.

Authors

Jiafu Wang¹, Yue Han², Lin Lin¹, Linhan Zhang¹, Jin Li³, Huiqi Gao¹, Peng Fu¹

Affiliations

¹ Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
² Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
³ Department of Integrative Medicine Oncology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.

Abstract

Background: To date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged.

Methods: Articles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: ⁶⁸Ga-prostate specific membrane antibody (⁶⁸Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS.

Results: Ultimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for ⁶⁸Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of ⁶⁸Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034.

Discussion: The meta-analysis showed that ⁶⁸Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.

Keywords: Positron emission tomography/computed tomography (PET/CT); bone scan; diagnostic value; meta-analysis; prostate disease.