Impact of ⁶⁸Ga-PSMA PET on the Management of Patients with Prostate Cancer: A Systematic Review and Meta-analysis

Context: ⁶⁸Gallium prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) is an emerging imaging modality for assessment of prostate cancer. Recent studies show promising results regarding its ability to detect recurrent or metastatic prostate cancer superior to that of conventional imaging modalities. However, the impact of ⁶⁸Ga-PSMA PET on management of patients with prostate cancer has not been well established.

Objective: To perform a systematic review and meta-analysis to evaluate the impact of ⁶⁸Ga-PSMA PET on management of patients with prostate cancer.

Evidence acquisition: Pubmed and EMBASE databases were searched up to January 20, 2018. We included studies that reported proportion of management change after ⁶⁸Ga-PSMA PET in patients with prostate cancer. The quality of the studies was evaluated using the GRADE system. The proportion of management changes were pooled using random-effects model. Subgroup analyses and meta-regression analyses were performed to explore heterogeneity.

Evidence synthesis: Fifteen studies (1163 patients) were included. The pooled proportion of management changes was 54% (95% confidence interval 47-60%). At meta-regression analyses, PET positivity (%) was a significant factor of heterogeneity (p=0.0486). For patients with biochemical failure, the proportion of radiotherapy (from 56% to 61%), surgery (from 1% to 7%), focal therapy (from 1% to 2%), and multimodal treatment (from 2% to 6%) increased, whereas that of systemic treatment (from 26% to 12%) and no treatment (from 14% to 11%) decreased with ⁶⁸Ga-PSMA PET.

Conclusions: ⁶⁸Ga-PSMA PET had a large impact on the management of patients with prostate cancer. Greater PET positivity was associated with higher proportion of management changes.

Patient summary: We reviewed all previous studies assessing the impact of ⁶⁸Gallium prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) in patients with prostate cancer. We found that ⁶⁸Ga-PSMA PET altered the management in approximately half of the patients.