PSMA PET/CT in primary prostate cancer diagnostics: an overview of the literature

Abstract

Imaging with radiotracers targeting the prostate-specific membrane antigen (PSMA) receptor is identified as a promising novel technique in prostate cancer (PCa) detection. In this paper we aim to summarize the current knowledge derived from the literature as well as the authors’ experiences on PSMA PET/CT in initial staging of PCa. PSMA PET/CT lesion- and template-based sensitivity and specificity respectively ranged from 35.1–96.1% and 96–100%. Patient-based sensitivity and specificity respectively ranged from 33.3–100% and 95–100%. Accuracy was 92% (95% CI 88–95) versus 65% (95% CI 60–69) compared to conventional imaging (CT and skeletal scintigraphy). PSMA PET/CT is superior for detection of metastases in primary PCa compared to conventional imaging. Also, PSMA PET/CT has a high specificity and moderate sensitivity for lymph node detection in primary PCa. For adequate initial staging, extended pelvic lymph node dissection (ePLND) will still be required, however, PSMA PET/CT can induce important management changes.