A Systematic Review on Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET) Evaluating Localized Low- to Intermediate-Risk Prostate Cancer: A Tool to Improve Risk Stratification for Active Surveillance?

Jianliang Liu; Jordan Santucci; Dixon T S Woon; Rick Catterwell; Marlon Perera; Declan G Murphy; Nathan Lawrentschuk

doi:10.3390/life14010076

A Systematic Review on Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA PET) Evaluating Localized Low- to Intermediate-Risk Prostate Cancer: A Tool to Improve Risk Stratification for Active Surveillance?

Life (Basel). 2024 Jan 2;14(1):76. doi: 10.3390/life14010076.

Authors

Jianliang Liu^{1

2

3

4}, Jordan Santucci^{2

4}, Dixon T S Woon^{1

3

5}, Rick Catterwell^{6

7}, Marlon Perera^{2

4

5}, Declan G Murphy^{3

4}, Nathan Lawrentschuk^{1

2

3

4}

Affiliations

¹ EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, VIC 3005, Australia.
² Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3052, Australia.
³ Department of Surgery, University of Melbourne, Melbourne, VIC 3052, Australia.
⁴ Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia.
⁵ Department of Urology, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia.
⁶ Department of Urology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
⁷ Discipline of Surgery, University of Adelaide, Adelaide, SA 5005, Australia.

Abstract

Active surveillance remains a treatment option for low- to intermediate-risk prostate cancer (PCa) patients. Prostate-specific membrane antigen positron emission tomography and computed tomography (PSMA PET/CT) has emerged as a useful modality to assess intraprostatic lesions. This systematic review aims to evaluate PSMA PET/CT in localized low- to intermediate-risk PCa to determine its role in active surveillance. Following PRISMA guidelines, a search was performed on Medline, Embase, and Scopus. Only studies evaluating PSMA PET/CT in localized low- to intermediate-risk PCa were included. Studies were excluded if patients received previous treatment, or if they included high-risk PCa. The search yielded 335 articles, of which only four publications were suitable for inclusion. One prospective study demonstrated that PSMA PET/CT-targeted biopsy has superior diagnostic accuracy when compared to mpMRI. One prospective and one retrospective study demonstrated MRI occult lesions in 12.3-29% of patients, of which up to 10% may harbor underlying unfavorable pathology. The last retrospective study demonstrated the ability of PSMA PET/CT to predict the volume of Gleason pattern 4 disease. Early evidence demonstrated the utility of PSMA PET/CT as a tool in making AS safer by detecting MRI occult lesions and patients at risk of upgrading of disease.

Keywords: active surveillance; prostate cancer; prostate-specific membrane antigen positron emission tomography/computed tomography.

Publication types

Review

Grants and funding

The corresponding author is a recipient of the 2023 Epworth Prostate Cancer Research Grant. The grant had no influence on the design, execution, or interpretation of the study results presented in this manuscript. The grant has enabled us to conduct this research independently and contribute valuable insights to the field.