Impact of PSMA PET on management of biochemical recurrent prostate cancer: a systematic review and meta-analysis of prospective studies

Prostate-specific membrane antigen positron emission tomography (PSMA PET) is a promising imaging modality for detection of biochemical recurrent prostate cancer (BRPCa). This systematic review and meta-analysis was to summarize the impact of PSMA PET on the management of BRPCa patients based on prospective studies. According to the PRISMA statement, articles in Pubmed and Embase were searched till May 26th, 2020 to identify eligible prospective studies that reported changes in the management of BRPCa patients after PSMA PET assessment. The quality of included studies was accessed using the Cochrane Collaboration tool. Meta-analysis was performed using a random-effects model. The pooled change proportion was calculated according to the type of change (just intended vs. implemented). Meta-regression was used to identify significant factors for heterogeneity. Eleven publications involving 1580 patients were included. The pooled proportion of management change in BRPCa patients was 61% (95% CI 55–68%) with significant heterogeneity (p < 0.01, I2 = 86%). Six studies involving 1190 patients were summarized in detail. The results showed that after PSMA PET, the proportion of active surveillance and target/localized therapy increased from 16.6 to 20.9%, and from 39.5 to 40.2%, respectively, while the proportion of comprehensive therapy decreased from 41.9 to 36.1%. In addition, the proportion of patients on androgen deprivation therapy (ADT) (%) at PSMA PET was identified as a significant factor affecting heterogeneity (p = 0.044). PSMA PET had an impact on the clinical management of BRPCa in 61% patients. A higher proportion ongoing ADT was associated with a higher proportion of management change.