Abstract

Purpose To assess the diagnostic performance of various imaging modalities in detecting and monitoring prostate cancer across different disease stages using diagnostic test accuracy (DTA) and network meta-analysis (NMA).

Methods A systematic literature review was conducted to identify studies evaluating mpMRI, PSMA PET/CT, MRE, MRSI, BS, CT, PET, and other tracers for prostate cancer detection. Data on sensitivity, specificity, PPV, NPV, and detection rate were extracted and analyzed using NMA.

Result Across 123 studies involving 9,371 patients, 68Ga-P16-093 PET/CT and 68Ga-PSMA-617 PET/CT showed high diagnostic accuracy in early-phase prostate cancer. For lymph node metastasis, 68Ga-PSMA-11 PET/MRI was the most sensitive. 18F-DCFPyL PET/CT had the highest specificity and PPV, while 18F-PSMA-1007 PET/CT had the highest NPV. In bone metastasis, 18F-PSMA-1007 PET/MRI excelled in sensitivity and NPV, while 18F-Fluciclovine PET/CT had the highest specificity and PPV. For biochemical recurrence, 18F-PSMA-1007 PET/CT had the highest lesion detection rate, and for different radiotracers, 18F-PSMA-1007 had the highest detection rate.

Conclusion This network meta-analysis comprehensively evaluated the diagnostic efficacy of various imaging modalities for prostate cancer across different stages. Our findings underscore the strengths and limitations of each imaging technique in detecting and staging prostate cancer.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Jilin Province Tianhua Health Foundation (J2023JKJ017)

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

AbbreviationsADTAndrogen Deprivation TherapyBSBone ScintigraphyBCRBiochemical RecurrenceCADComputer-Aided DiagnosisCIConfidence IntervalCNNConvolutional Neural NetworkcsPCaClinically Significant Prostate CancerCTComputed TomographyDCE-MRIDynamic Contrast-Enhanced MRIDCFPyLPiflufolastatDREDigital Rectal ExaminationDRDetection RateDTADiagnostic Test AccuracyDWIDiffusion-Weighted ImagingEAUEuropean Association of UrologyEANMEuropean Association of Nuclear MedicineESTROEuropean Society for Radiotherapy & OncologyESUREuropean Society of Urogenital RadiologyECEExtracapsular ExtensionFDGFluoro-2-deoxy-D-glucoseFNFalse NegativeFPFalse PositiveISUPInternational Society of Urological PathologymiTNMMolecular Imaging Standardized Evaluation TNM ClassificationmpMRIMultiparametric Magnetic Resonance ImagingMRSIMagnetic Resonance Spectroscopy ImagingMREMagnetic Resonance ElastographyNMANetwork Meta-analysisNPVNegative Predictive ValueOROdds RatioPCaProstate CancerPETPositron Emission TomographyPET/CTPositron Emission Tomography/Computed TomographyPET/MRIPositron Emission Tomography/Magnetic Resonance ImagingPI-RADSProstate Imaging Reporting and Data SystemPPVpositive predictive valuePSAProstate-Specific AntigenPSMAProstate-Specific Membrane AntigenQUADAS-2Quality Assessment of Diagnostic Accuracy StudiesRPRadical ProstatectomySeSensitivitySpSpecificitySPECTSingle Photon Emission Computed TomographySREsSkeletal-Related EventsSUCRASurface Under Cumulative Ranking CurveSUVStandardized Uptake ValueSUVmaxMaximum Standardized Uptake ValueSVISeminal Vesicle InvasionTPTrue PositiveTNTrue NegativeUBUUnspecific Bone Uptake