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Effect of PSA on diagnostic yield of 68Ga-PSMA PET in advanced prostate cancer: A systematic review and meta-analysis


Perera M.1, Papa N.1, Christidis D.1, Wetherell D.1, Hofman M.2, Murphy D.3, Bolton D.1, Lawrentschuk N.1


1Austin Health, Dept. of Surgery, Melbourne, Australia, 2Peter MacCallum, Dept. of Radiology, Melbourne, Australia, 3Peter MacCallum, Dept. of Surgical Oncology, Melbourne, Australia

Introduction & Objectives

Traditional imaging modalities for advanced prostate cancer include PET/CT with choline-based tracers. Such modalities provide limited detection rates, particularly in patients with low-PSA levels during the early stages of biochemical recurrence. 68Ga PSMA-PET is an emerging imaging that provides the ability to selectively identify and localize metastatic prostate cancer. Current reports suggest improved detection rates in patients with low-levels of PSA in the setting of biochemical recurrence. We undertook a systematic review and meta-analysis of reported predictors of positive 68Ga PSMA-PET/CT in the setting of advanced prostate cancer.

Material & Methods

We performed critical reviews of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using Quality Assessment if Diagnostic Accuracy Studies-2 tool. Meta-analysis and meta-regression of proportions were performed using a random-effects model with pre-PET PSA levels as the dependent variable.


Seventeen articles including 1,841 patients were analysed. Overall percentage of positive 68Ga PSMA-PET was 44% (95% CI: 18-72%) for primary staging patients and 76% (95% CI: 66-85%) or biochemical recurrence (BCR) patients. Positive 68Ga PSMA-PET scans for BCR patients increased with higher pre-PET PSA. For PSA categories 0-0.2ng/ml, 0.2-1ng/ml, 1-2 ng/ml and > 2 ng/ml, the percentage positive were 30%, 53%, 78% and 96% respectively. Shorter PSA doubling time increased 68Ga PSMA-PET positivity.


In the setting of biochemically recurrent prostate cancer, pre-PET PSA predicts the risk of positive 68Ga PSMA-PET. Compared to traditional imaging modalities, 68Ga PSMA-PET appears to provide improved prostate cancer detection at lower PSA levels.

  • Type: Abstract
  • Date: 24-11-2016
  • Rating: 0,0
  • Views: 110
  • Event: 5th Meeting of the EAU Section of Urological Imaging (ESUI)
  • Nr: EP180