Diagnostic performance of 18F‑DCFPyL PET vs. 68Ga‑PSMA PET/CT in patients with suspected prostate cancer: A systemic review and meta‑analysis
- Authors:
- Published online on: February 29, 2024 https://doi.org/10.3892/ol.2024.14321
- Article Number: 188
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Copyright: © Jiang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Abstract
Introduction
The second most frequent disease globally and the fifth most common cause of cancer-related mortality in men is prostate cancer (PCa) (1). Digital rectal examination and serum prostate-specific antigen (PSA) testing, followed by transrectal ultrasonography (TRUS)-guided biopsy, have historically been used to identify PCa (2). Despite being the preferred approach for PCa diagnosis, TRUS-guided biopsy has several inherent drawbacks. A TRUS-guided biopsy may ignore abnormalities in the anterior and apical prostate, producing false-negative findings in addition to being an invasive treatment with a chance of potentially life-threatening infections (3). As a result, it is critical to investigate alternative strategies that may decrease the number of needless prostate biopsies or perhaps completely replace puncture biopsy to diagnose PCa (4,5).
A non-invasive diagnostic called multiparametric MRI (mpMRI) has great potential for identifying and staging PCa (6). The Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1), the most recent version of the structured reporting system for mpMRI, aims to improve inter-reader agreement and streamline the evaluation of prostate mpMRI using PI-RADS criteria (7). Despite these developments, mpMRI also has numerous defects, such as false-positive results (8) and new histopathological patterns (9), and alternative non-invasive diagnostic modalities still need to be researched and used.
A type II transmembrane glycoprotein called prostate-specific membrane antigen (PSMA) is overexpressed in almost all cases of PCa (10–12). However, the clinical use of the nuclide 68Ga has been constrained by the cost, its short half-life and high electron energy during synthesis. Specifically, producing 68Ga is costly due to the need for specialized equipment. Its short half-life requires rapid use, challenging for centers far from production sites. The high electron energy needed for creating 68Ga compounds adds to the complexity and cost, limiting its wider clinical use (13). The most frequently utilized positron nuclide in clinical practice has been 18F-DCFPyL, based on a glutamate-urea-lysine structure. In contrast to 68Ga-PSMA-11, 18F-DCFPyL has excellent affinity, advantageous in vivo pharmacokinetics, good solubility and the possibility for a better rate of minor lesion detection. As a result, it performs better and is more appropriate for broader usage in clinical practice (14–16).
Only a few studies have evaluated the use of 18F-DCFPyL PET and 68Ga-PSMA PET/CT in the diagnosis of patients with suspected PCa; most of this research involved patients with biopsy-proven PCa. In the present study, a meta-analysis was performed using previously published data to acquire complete comprehension of the diagnostic performance of 18F-DCFPyL PET and 68Ga-PSMA PET/CT in evaluating patients with suspected PCa.
Methods
Search strategy
The guidelines for preferred reporting items for systematic reviews and meta-analyses (PRISMA) (17) were followed when conducting this study. The protocol for this study was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols database on February 13, 2024 (INPLASY202420059) and is available in full on inplasy (https://doi.org/10.37766/inplasy2024.2.0059).
Using the PubMed (http://pubmed.ncbi.nlm.nih.gov/), Embase (www.embase.com) and Web of Science (https://www.webofscience.com/) databases, a comprehensive search for literature up until September 2023 was conducted. ‘Positron-Emission Tomography’ OR ‘PET’ OR ‘Positron Emission Tomography Imaging’ OR ‘PET Scan’ OR ‘PET Imaging’ AND ‘Prostate Specific Membrane Antigen’ OR ‘PSMA’ AND ‘Prostate Neoplasms’ OR ‘Prostatic Cancers’ OR ‘Prostatic Cancer’ OR ‘Prostatic Neoplasm’ OR ‘Prostate Neoplasm’ OR ‘Prostate tumor’ were the key words used (Table SI). Two researchers (JG and LH) independently integrated computer-generated search results with manual searches to ensure diversity and prevent omitting pertinent literature. In addition, the list of references included in the study was screened to find any other articles that were left out in the initial search.
Inclusion and exclusion criteria
Studies were considered eligible for inclusion if they met all of the following criteria: i) They involved untreated patients with suspected PCa, which included individuals whose prostates had abnormalities found during an abnormal PSA test, an abnormal MRI scan or a digital rectal examination; ii) diagnostic imaging was performed using an 18F-DCFPyL PET scan or a 68Ga-PSMA PET/CT scan; iii) the reference standard used for comparison was histological biopsy and histopathology; and iv) the number of subjects was ≥10.
The following exclusion criteria were applied: i) Duplicate articles; ii) abstracts, editorial comments, letters, case reports, reviews or meta-analyses; iii) titles and abstracts that were clearly irrelevant; iv) insufficient data to perform calculations; and v) articles not written in English.
Two researchers (JG and LH) meticulously assessed the titles and abstracts of the retrieved papers whilst applying the above-mentioned inclusion and exclusion criteria. Following this initial screening procedure, the full-text versions of the remaining articles were carefully examined to determine whether they were appropriate for inclusion in the ensuing stage. The researchers reached a consensus in a discussion with a third author (ZJ) to resolve any disagreements during the evaluation.
Quality assessment and data extraction
Using the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) method, two researchers (SY and BM) independently assessed the quality of the included articles (18). The following areas of each study were evaluated: Patient selection, the index test, the reference standard and the flow and timing of the study. These domains were assessed for risk of bias and given a high, low or unclear applicability rating. Discussions with a third reviewer (ZJ) helped to settle any differences that came up.
For each study, two researchers independently extracted the data. General information, characteristics of the literature, demographic information regarding the patients, technical information and outcomes related to the total number of patients, as well as true positive (TP), false positive (FP), true negative (TN) and false negative (FN) counts, were all included in the data. These values were computed using test findings for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in cases where they weren't expressly provided. The sensitivity was calculated as the ratio of TP to the sum of TP and FN [sensitivity=TP/(TP + FN)], while specificity was calculated as the ratio of TN to the sum of TN and FP [specificity=TN/(TN + FP)]. The PPV was derived as the ratio of TP to the sum of TP and FP [PPV=TP/(TP + FP)], and the NPV as the ratio of TN to the sum of TN and FN [NPV=TN/(TN + FN)]. These formulas allowed for a consistent and objective assessment of the diagnostic performance across the included studies.
Statistical analysis
The best outcome was chosen for analysis when the included publications provided a range of diagnostic performances based on cut-off thresholds for classifying positive and negative scans. Stata 16.0 (StataCorp LP) and Meta-Disc 1.4 (http://www.hrc.es/investigacion/metadisc_en.htm) were used to examine the data of a four-grid table. As the bivariate random-effects model can simultaneously adapt to the inherent correlation between the sensitivity and specificity of different studies, it also explains the heterogeneity between studies (19). Using a bivariate random random-effects model, the pooled sensitivity and specificity for 18F-DCFPyL PET and 68Ga-PSMA PET/CT were reported as estimates with 95% confidence intervals (CIs). In addition, because the summary receiver operating characteristic (SROC) model facilitates the interpretation of diagnostic test accuracy in the presence of heterogeneity and varying threshold effects, this model was used to generate the SROC curve and determine the area under the curve (AUC) (19,20). The difference of the pooled AUC between 18F-DCFPyL PET and 68Ga-PSMA PET/CT was analyzed using Z test statistics (21,22).
Using the I2 statistic, the heterogeneity between the pooled studies was evaluated. Meta-regression analysis was used to explore potential causes of heterogeneity when there was significant heterogeneity (I2>50%) (23). The funnel plot test developed by Deek was used to evaluate publication bias. Stata 16.0 and Meta-Disc 1.4 were used for all statistical calculations. Statistical significance was defined as P<0.05.
Results
Literature search and study selection
A total of 9,752 entries were found in the original search and 3,615 duplicates were removed, leaving 6,137 articles for further analysis. After examining the titles and abstracts, 5,980 items were deemed unrelated and discarded. The 105 unrelated studies, 6 articles not published in English, 16 articles using various radiotracers and 17 articles not providing sufficient data for the computation were all eliminated after further study of the remaining articles. Finally, 13 studies (24–36) assessing the diagnostic performance of 18F-DCFPyL PET or 68Ga-PSMA PET/CT were considered eligible for meta-analysis. The study selection procedure is depicted by a PRISMA flow diagram in Fig. 1.
Study description and quality assessment
There were 1,178 patients with suspected PCa in the 13 qualifying studies. The mean of the median and mean ages of the patients in the evaluable articles was 67.4 years (range, 43–90 years). The study and patient characteristics are listed in Table I and the technical details of 18F-DCFPyL PET and 68Ga-PSMA PET/CT are provided in Table II.
Fig. 2 shows the results of the risk of bias assessment for these 13 studies, which was performed using the QUADAS-2 technique. The included studies' quality was deemed to be adequate.
Quantitative synthesis
The analysis comprised a total of 13 trials with 1,178 patients. The pooled sensitivity and specificity of 18F-DCFPyL PET for suspected PCa were 0.92 (95% CI, 0.85–0.96) and 0.59 (95% CI, 0.08–0.96), respectively. The pooled sensitivity and specificity for 68Ga-PSMA PET/CT were, respectively, 0.96 (95% CI, 0.88–0.99) and 0.71 (95% CI, 0.57–0.82) (Fig. 3).
In the SROC analysis, the AUC for 18F-DCFPyL PET and 68Ga-PSMA PET/CT were calculated to be 0.92 (95% CI, 0.89–0.94) and 0.92 (95% CI, 0.89–0.94) and there was no statistically significant difference according to Z-test statistics (Z<0.001, P<0.999) (Fig. 4).
Furthermore, the Fagan nomogram in Fig. 5 showed that the post-test probabilities for 18F-DCFPyL PET and 68Ga-PSMA PET/CT could rise to 69 and 77%, respectively, when the pre-test probability was 50%.
Heterogeneity analysis
The I2 values for 18F-DCFPyL PET's pooled sensitivity and specificity for primary cancer were 49.29 and 97.07%, respectively. The corresponding I2 values for 68Ga-PSMA PET/CT's heterogeneity were 50.49 and 79.57% (Fig. 3). It was attempted to identify the cause of heterogeneity by using meta-regression analysis. It demonstrated that diversities in geographical region and study design were two potential causes of heterogeneity for these two imaging agents (Tables III and IV).
 | Table IV.Meta-regression and subgroup analyses of 68Ga-prostate-specific membrane antigen positron emission tomography/CT. |
In addition, Deek's funnel plot showed no evidence of publishing bias for both imaging modalities, with P-values of 0.17 and 0.90 (Fig. 6).
Discussion
Currently, there is a scarcity of studies investigating the application of 18F-DCFPyL PET and 68Ga-PSMA PET/CT in the diagnosis of suspected PCa. The present study was the first meta-analysis on the comparative efficacy of 18F-DCFPyL PET and 68Ga-PSMA PET/CT in the detection of PCa in patients with a suspicion of the disease. The purpose of the present study was to quantitatively assess and evaluate the diagnostic accuracy of two different diagnostic methods for patients with suspected PCa. Based on the results, 18F-DCFPyL PET demonstrated a pooled sensitivity, specificity and AUC of 0.92, 0.59 and 0.92, respectively. 68Ga-PSMA PET/CT exhibited a pooled sensitivity, specificity and AUC of 0.96, 0.71 and 0.92, respectively. This suggests that both 18F-DCFPyL PET and 68Ga-PSMA PET/CT have the potential to serve as ‘rule-out’ tests for patients suspected of having PCa based on clinical or biochemical evidence. Consequently, these tests can help avoid unnecessary biopsies.
Numerous PCa cases progress slowly and typically do not produce severe symptoms, thereby not necessitating immediate active treatment or intervention (37,38). Therefore, there is a strong emphasis on detecting clinically relevant PCa at an early stage. Clinically relevant PCa often refers to tumors with a Gleason score of 3+4 or higher (39). The present findings indicate that both 18F-DCFPyL PET and 68Ga-PSMA PET/CT had a high level of accuracy in detecting clinically significant tumors. The pooled sensitivity for 18F-DCFPyL PET was 0.92, while that for 68Ga-PSMA PET/CT was 0.96. These findings have the potential to impact the categorization of risk and improve the decision-making process for treating such patients (40).
In the present meta-analysis, a comprehensive evaluation of the efficacy of two imaging methods in identifying suspected PCa was performed. The AUC for 18F-DCFPyL PET and 68Ga-PSMA PET/CT in identifying suspected PCa was 0.92 (95% CI: 0.89–0.94) for both. Although there was no statistical difference by Z-test statistics (Z<0.001, P<0.999), 68Ga-PSMA PET/CT was indicated to have higher sensitivity, specificity and post-test probability compared to 18F-DCFPyL PET. The present results indicated that 18F-DCFPyL and 68Ga-PSMA PET/CT have similar diagnostic accuracy in detecting suspected PCa. Van Kalmthout et al (41) discovered in their earlier research that the diagnostic performance of both 18F-DCFPyL and 68Ga-PSMA PET/CT in the setting of biochemical recurrence of PCa post-prostatectomy is comparable. Perhaps the similarity in biodistribution patterns of 18F-DCFPyL and 68Ga-PSMA in normal tissues is due to their comparable characteristics (42). In addition, it has been indicated that 68Ga-PSMA PET/CT remains highly valuable due to its accessibility and cost-effectiveness (43), although 18F-DCFPyL PET may offer slight advantages in terms of imaging clarity and patient safety in certain contexts (44). However, the finding was derived from a limited sample size and thus, the reliability of the results may be limited.
In the present study, papers that assessed the diagnostic performance of 18F-DCFPyL PET and 68Ga-PSMA PET/CT for suspected PCa were analyzed using various thresholds for detecting positive and negative scans. Of note, a consensus on the precise diagnostic threshold choice for different imaging techniques has yet to be obtained. Studies have used measurements such as the standardized uptake value threshold and the choline/creatinine ratio. The reported sensitivity and specificity of the imaging technique may change depending on the choice of diagnostic thresholds (45). In some of the included articles, ROC curves were generated to assess diagnostic performance, and the diagnostic threshold that produced the highest sensitivity and specificity products was chosen. Although this method of determining the ideal diagnostic threshold is frequently utilized, it may only be suitable under certain circumstances, mainly when there is a trade-off between sensitivity and specificity. Therefore, additional research examining the ideal diagnostic cutoff for 68Ga-PSMA PET/CT and 18F-DCFPyL PET in patients with suspected PCa is necessary.
The identification of significant heterogeneity in the present examination of 18F-DCFPyL PET and 68Ga-PSMA PET/CT, as evidenced by an I2-value exceeding 50%, highlights the complex and diverse characteristics of diagnostic accuracy research in this field. In the following meta-regression analysis, it was attempted to find the underlying factors that contribute to the observed heterogeneity. It was indicated that the diversity in geographical region among the research populations, as well as the combination of prospective and retrospective study designs, were significant factors. However, it is crucial to recognize that the observed heterogeneity can also be attributed to methodological differences, such as variations in imaging techniques, thresholds for determining positives and discrepancies in the criteria used to choose patients among the studies included. These factors indicate that, although specific variables have a significant impact on heterogeneity, a wider range of methodological and clinical factors should be considered when interpreting the results of diagnostic accuracy meta-analyses in PCa imaging.
The present study acknowledges several methodological limitations that warrant careful consideration. First, the relatively small sample size, with only 13 studies included, restricts the statistical power and robustness of the present findings. This limitation underscores the need for caution when extrapolating the present results to broader populations. Furthermore, the heterogeneity introduced by differing diagnostic cutoffs and design of the included studies was a challenge. Such heterogeneity may lead to biases in the synthesis of data, particularly in deciding which results are emphasized, potentially skewing the overall interpretation of diagnostic efficacy. In addition, the study's selection criteria may have inadvertently resulted in a narrow representation of geographical region. This limitation is significant because the diagnostic performance of the tests under review may vary across different regional groups, thereby affecting the applicability of the conclusions across diverse populations. Finally, the reliance on histology and follow-up as the gold standard for confirming tumor recurrence is a critical point for consideration. The fact that not all patients in the included studies had accessible confirmatory pathology results introduces an element of uncertainty regarding the diagnostic precision of the imaging modalities evaluated. This limitation is particularly pertinent, as it may compromise the reliability of the current findings. Considering these limitations, the conclusions of the present study should be interpreted with caution. The identified weaknesses and sources of heterogeneity highlight the need for additional, more comprehensive research to validate and extend the current findings, ensuring their relevance and applicability to a wide range of clinical contexts.
From the pooled data it was inferred that the diagnostic performance of 18F-DCFPyL PET and 68Ga-PSMA PET/CT is comparable in patients with suspected PCa. Although only a small number of studies have been carried out thus far, it is significant to emphasize that the comparative evidence in this field currently needs to be more extensive. Therefore, subsequent studies concentrating on direct head-to-head comparisons of these two radiotracers may produce fresh and intriguing findings, offering new insight into the diagnostic capacities of these imaging modalities.
In conclusion, comparable diagnostic performance is seen for patients with suspected PCa using 18F-DCFPyL PET and 68Ga-PSMA PET/CT. It is suggested that both modalities can be valuable tools in the diagnostic arsenal against this prevalent disease, underscoring the potential for flexibility in clinical choices, based on availability and patient-specific factors. However, given the modest sample sizes of the studies included in the present meta-analysis, it is crucial to interpret these results with caution. Further studies with larger, more diverse populations are essential to solidify our understanding and refine suspected PCa diagnostic protocols. Such research will also help in addressing the limitations identified, ultimately contributing to more effective and personalized patient care.
Supplementary Material
Supporting Data
Acknowledgements
Not applicable.
Funding
This work was supported by the University Student Innovation and Entrepreneurship Training Program Project (grant no. S202210541145), the Key Projects of Hunan Provincial Department of Education (grant no. 21A0242) and the General Project of Hunan Natural Science Foundation (grant no. 2021JJ30506).
Availability of data and materials
The data generated in the present study may be requested from the corresponding author.
Authors' contributions
QT and ZJ conceived of and designed the study. JG, SY and BM performed data acquisition, data analysis and manuscript preparation. ZJ, JG, LH and SY assisted with data acquisition, data analysis and statistical analysis. ZJ and BM confirm the authenticity of all the raw data. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Not applicable.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
References
|
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. 2018. View Article : Google Scholar : PubMed/NCBI | |
|
Descotes JL: Diagnosis of prostate cancer. Asian J Urol. 6:129–136. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Lomas DJ and Ahmed HU: All change in the prostate cancer diagnostic pathway. Nat Rev Clin Oncol. 17:372–381. 2020. View Article : Google Scholar : PubMed/NCBI | |
|
Stefanova V, Buckley R, Flax S, Spevack L, Hajek D, Tunis A, Lai E and Loblaw A; Collaborators: Transperineal prostate biopsies using local anesthesia: Experience with 1,287 patients. prostate cancer detection rate, complications and patient tolerability. J Urol. 201:1121–1126. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Liss MA, Ehdaie B, Loeb S, Meng MV, Raman JD, Spears V and Stroup SP: An update of the American urological association white paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol. 198:329–334. 2017. View Article : Google Scholar : PubMed/NCBI | |
|
Ghai S and Haider MA: Multiparametric-MRI in diagnosis of prostate cancer. Indian J Urol. 31:194–201. 2015. View Article : Google Scholar : PubMed/NCBI | |
|
Turkbey B, Rosenkrantz AB, Haider MA, Padhani AR, Villeirs G, Macura KJ, Tempany CM, Choyke PL, Cornud F, Margolis DJ, et al: Prostate Imaging reporting and data system version 2.1: 2019 Update of prostate imaging reporting and data system version 2. Eur Urol. 76:340–351. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Laudicella R, Rüschoff JH, Ferraro DA, Brada MD, Hausmann D, Mebert I, Maurer A, Hermanns T, Eberli D, Rupp NJ and Burger IA: Infiltrative growth pattern of prostate cancer is associated with lower uptake on PSMA PET and reduced diffusion restriction on mpMRI. Eur J Nucl Med Mol Imaging. 49:3917–3928. 2022. View Article : Google Scholar : PubMed/NCBI | |
|
Rüschoff JH, Ferraro DA, Muehlematter UJ, Laudicella R, Hermanns T, Rodewald AK, Moch H, Eberli D, Burger IA and Rupp NJ: What's behind 68Ga-PSMA-11 uptake in primary prostate cancer PET? Investigation of histopathological parameters and immunohistochemical PSMA expression patterns. Eur J Nucl Med Mol Imaging. 48:4042–4053. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Wright GL Jr, Haley C, Beckett ML and Schellhammer PF: Expression of prostate-specific membrane antigen in normal, benign, and malignant prostate tissues. Urol Oncol. 1:18–28. 1995. View Article : Google Scholar : PubMed/NCBI | |
|
Silver DA, Pellicer I, Fair WR, Heston WD and Cordon-Cardo C: Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res. 3:81–85. 1997.PubMed/NCBI | |
|
Ross JS, Sheehan CE, Fisher HA, Kaufman RP Jr, Kaur P, Gray K, Webb I, Gray GS, Mosher R and Kallakury BV: Correlation of primary tumor prostate-specific membrane antigen expression with disease recurrence in prostate cancer. Clin Cancer Res. 9:6357–6362. 2003.PubMed/NCBI | |
|
Evangelista L, Maurer T, van der Poel H, Alongi F, Kunikowska J, Laudicella R, Fanti S and Hofman MS: [68Ga]Ga-PSMA Versus [18F]PSMA positron emission tomography/computed tomography in the staging of primary and recurrent prostate cancer. A systematic review of the literature. Eur Urol Oncol. 5:273–282. 2022. View Article : Google Scholar : PubMed/NCBI | |
|
Koerber SA, Utzinger MT, Kratochwil C, Kesch C, Haefner MF, Katayama S, Mier W, Iagaru AH, Herfarth K, Haberkorn U, et al: 68Ga-PSMA-11 PET/CT in newly diagnosed carcinoma of the prostate: Correlation of intraprostatic PSMA uptake with several clinical parameters. J Nucl Med. 58:1943–1948. 2017. View Article : Google Scholar : PubMed/NCBI | |
|
Rowe SP, Macura KJ, Mena E, Blackford AL, Nadal R, Antonarakis ES, Eisenberger M, Carducci M, Fan H, Dannals RF, et al: PSMA-based [(18)F]DCFPyL PET/CT is superior to conventional imaging for lesion detection in patients with metastatic prostate cancer. Mol Imaging Biol. 18:411–419. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
Rowe SP, Mana-Ay M, Javadi MS, Szabo Z, Leal JP, Pomper MG, Pienta KJ, Ross AE and Gorin MA: PSMA-based detection of prostate cancer bone lesions with 18F-DCFPyL PET/CT: A sensitive alternative to (99m)Tc-MDP bone scan and Na18F PET/CT? Clin Genitourin Cancer. 14:e115–e118. 2016. View Article : Google Scholar : PubMed/NCBI | |
|
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 372:n712021. View Article : Google Scholar : PubMed/NCBI | |
|
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA and Bossuyt PM; QUADAS-2 Group, : QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 155:529–536. 2011. View Article : Google Scholar : PubMed/NCBI | |
|
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM and Zwinderman AH: Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 58:982–990. 2005. View Article : Google Scholar : PubMed/NCBI | |
|
Moses LE, Shapiro D and Littenberg B: Combining independent studies of a diagnostic test into a summary ROC curve: Data-analytic approaches and some additional considerations. Stat Med. 12:1293–1316. 1993. View Article : Google Scholar : PubMed/NCBI | |
|
DeLong ER, DeLong DM and Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics. 44:837–845. 1988. View Article : Google Scholar : PubMed/NCBI | |
|
Hanley JA and McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 143:29–36. 1982. View Article : Google Scholar : PubMed/NCBI | |
|
Lin M, Li YR, Lan QW, Long LJ, Liu JQ, Chen YW, Cao XJ, Wu GY, Li YP and Guo XG: Evaluation of GeneXpert EV assay for the rapid diagnosis of enteroviral meningitis: A systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 21:252022. View Article : Google Scholar : PubMed/NCBI | |
|
Bodar YJL, Jansen BHE, van der Voorn JP, Zwezerijnen GJC, Meijer D, Nieuwenhuijzen JA, Boellaard R, Hendrikse NH, Hoekstra OS, van Moorselaar RJA, et al: Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: Is PSMA-targeted biopsy feasible? The DeTeCT trial. World J Urol. 39:2439–2446. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Metser U, Ortega C, Perlis N, Lechtman E, Berlin A, Anconina R, Eshet Y, Chan R, Veit-Haibach P, van der Kwast TH, et al: Detection of clinically significant prostate cancer with 18F-DCFPyL PET/multiparametric MR. Eur J Nucl Med Mol Imaging. 48:3702–3711. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Zhang T, Yang S, Lin L, Wang S, Xia D, Chen D, Wang G, Zhao K and Su X: Role of 18F-DCFPyL PET/CT in patients with suspected prostate cancer. Hell J Nucl Med. 25:11–18. 2022.PubMed/NCBI | |
|
Liu Y, Dong Y, Liu J, Zhang X, Lin M and Xu B: Comparison between 18 F-DCFPyL PET and MRI for the detection of transition zone prostate cancer. Prostate. 81:1329–1336. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Parathithasan N, Perry E, Taubman K, Hegarty J, Talwar A, Wong LM and Sutherland T: Combination of MRI prostate and 18F-DCFPyl PSMA PET/CT detects all clinically significant prostate cancers in treatment-naive patients: An international multicentre retrospective study. J Med Imaging Radiat Oncol. 66:927–935. 2022. View Article : Google Scholar : PubMed/NCBI | |
|
Hoffmann MA, Miederer M, Wieler HJ, Ruf C, Jakobs FM and Schreckenberger M: Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT. Oncotarget. 8:111073–111083. 2017. View Article : Google Scholar : PubMed/NCBI | |
|
Lopci E, Saita A, Lazzeri M, Lughezzani G, Colombo P, Buffi NM, Hurle R, Marzo K, Peschechera R, Benetti A, et al: 68Ga-PSMA positron emission tomography/computerized tomography for primary diagnosis of prostate cancer in men with contraindications to or negative multiparametric magnetic resonance imaging: A prospective observational study. J Urol. 200:95–103. 2018. View Article : Google Scholar : PubMed/NCBI | |
|
Sasikumar A, Joy A, Pillai AMR, Oommen KE, Somarajan S, Raman VK, Thomas R and Dinesh D: Gallium 68-PSMA PET/CT for lesion characterization in suspected cases of prostate carcinoma. Nucl Med Commun. 39:1013–1021. 2018. View Article : Google Scholar : PubMed/NCBI | |
|
Kumar N, Yadav S, Kumar S, Saurav K, Prasad V and Vasudeva P: Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml. Indian J Urol. 35:202–207. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Zhang J, Shao S, Wu P, Liu D, Yang B, Han D, Li Y, Lin X, Song W, Cao M, et al: Diagnostic performance of 68Ga-PSMA PET/CT in the detection of prostate cancer prior to initial biopsy: Comparison with cancer-predicting nomograms. Eur J Nucl Med Mol Imaging. 46:908–920. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Liu C, Liu T, Zhang Z, Zhang N, Du P, Yang Y, Liu Y, Yu W, Li N, Gorin MA, et al: 68Ga-PSMA PET/CT combined with PET/ultrasound-guided prostate biopsy can diagnose clinically significant prostate cancer in men with previous negative biopsy results. J Nucl Med. 61:1314–1319. 2020. View Article : Google Scholar : PubMed/NCBI | |
|
Lopci E, Lughezzani G, Castello A, Saita A, Colombo P, Hurle R, Peschechera R, Benetti A, Zandegiacomo S, Pasini L, et al: Prospective evaluation of 68Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography in primary prostate cancer diagnosis. Eur Urol Focus. 7:764–771. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Jiao J, Kang F, Zhang J, Quan Z, Wen W, Zhao X, Ma S, Wu P, Yang F, Guo W, et al: Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68Ga-PSMA PET/CT: A real-world study. Theranostics. 11:8396–8411. 2021. View Article : Google Scholar : PubMed/NCBI | |
|
Cooperberg MR, Broering JM and Carroll PR: Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 28:1117–1123. 2010. View Article : Google Scholar : PubMed/NCBI | |
|
Esserman LJ, Thompson IM Jr and Reid B: Overdiagnosis and overtreatment in cancer: An opportunity for improvement. JAMA. 310:797–798. 2013. View Article : Google Scholar : PubMed/NCBI | |
|
Matoso A and Epstein JI: Defining clinically significant prostate cancer on the basis of pathological findings. Histopathology. 74:135–145. 2019. View Article : Google Scholar : PubMed/NCBI | |
|
Heidenreich A, Rieke M, Mahjoub S and Pfister D: Management of positive lymph nodes following radical prostatectomy. Arch Esp Urol. 72:182–191. 2019.PubMed/NCBI | |
|
Van Kalmthout L, Wondergem M, Jansen B, et al: Comparison of 68Ga-PSMA-11 and 18F-DCFPyL in prostate cancer patients with biochemical recurrence after prostatectomy. Eur J Nucl Med Mol Imaging. 46:S3692019.PubMed/NCBI | |
|
Ferreira G, Iravani A, Hofman MS and Hicks RJ: Intra-individual comparison of 68Ga-PSMA-11 and 18F-DCFPyL normal-organ biodistribution. Cancer Imaging. 19:232019. View Article : Google Scholar : PubMed/NCBI | |
|
van der Sar ECA, Keusters WR, van Kalmthout LWM, Braat AJAT, de Keizer B, Frederix GWJ, Kooistra A, Lavalaye J, Lam MGEH and van Melick HHE: Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging. Insights Imaging. 13:1322022. View Article : Google Scholar : PubMed/NCBI | |
|
Dietlein M, Kobe C, Kuhnert G, Stockter S, Fischer T, Schomäcker K, Schmidt M, Dietlein F, Zlatopolskiy BD, Krapf P, et al: Comparison of [(18)F]DCFPyL and [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol. 17:575–584. 2015. View Article : Google Scholar : PubMed/NCBI | |
|
Ertürk SA, Şalk İ, Yücel B, Ulaş Babacan Ö and Hasbek Z: The relationship between the SUVmax value obtained in Ga-68 PSMA PET/CT and lactate dehydrogenase and alkaline phosphatase in prostate cancer. Arch Esp Urol. 75:552–558. 2022. View Article : Google Scholar : PubMed/NCBI |
