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Comparing the Staging/Restaging Performance of 68Ga-Labeled Prostate-Specific Membrane Antigen and 18F-Choline PET/CT in Prostate Cancer

A Systematic Review and Meta-analysis

Lin, Chun-Yi, MD, DrPH*†; Lee, Ming-Tsung, PhD; Lin, Cheng-Li, MSc§∥; Kao, Chia-Hung, MD¶**††

doi: 10.1097/RLU.0000000000002526
Original Articles
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Purpose PET/CT using prostate-specific membrane antigen (PSMA) and choline radiotracers is widely used for diagnosis of prostate cancer. However, the roles of and differences in diagnostic performance between these 2 radiotracers for prostate cancer are unclear. The aim of this study was to compare the staging and restaging performance of 68Ga-labeled PSMA and 18F-choline PET/CT imaging in prostate cancer.

Methods A comprehensive search was performed in PubMed for studies reporting the staging performance of 68Ga-PSMA and 18F-choline PET/CT in prostate cancer from the inception of the database to October 1, 2018, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Thirty-five studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for 68Ga-PSMA and 18F-choline PET/CT were calculated alongside 95% confidence intervals. Summary receiver operating characteristic curves were plotted, and the area under the summary receiver operating characteristic curve (AUC) was determined alongside the Q* index.

Results The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (13 studies) were 0.92, 0.94, 7.91, 0.14, 79.04, and 0.96, respectively, whereas those of 18F-choline PET/CT (16 studies) were 0.93, 0.83, 4.98, 0.10, 68.27, and 0.95. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (9 studies) were 0.83, 0.95, 23.30, 0.17, 153.58, and 0.94, respectively, and those of 18F-choline PET/CT (4 studies) were 0.81, 0.92, 8.59, 0.20, 44.82, and 0.98. In both patient- and lesion-based imaging, there was no statistically significant difference in the abilities of detecting or excluding prostate cancer between 68Ga-PSMA PET/CT and 18F-choline PET/CT.

Conclusions For staging and restaging performance in patients with prostate cancer, there was no significant difference between 68Ga-PSMA PET/CT and 18F-choline PET/CT. 68Ga-PSMA PET/CT and 18F-choline PET/CT have demonstrated high diagnostic performance for accurate staging and restaging in patients with prostate cancer, and thus both should be considered for staging in this disease.

From the *School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei;

Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua; and

Research Assistant Center, Show Chwan Memorial Hospital, Changhua;

§Management Office for Health Data, China Medical University Hospital, Taichung;

College of Medicine, China Medical University, Taichung;

Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung;

**Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung; and

††Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.

Received for publication November 29, 2018; revision accepted January 24, 2019.

Conflicts of interest and sources of funding: This study was funded by grants from the Ministry of Health and Welfare, Taiwan (MOHW108-TDU-B-212-133004), China Medical University Hospital; Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039-004-); Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan, China Medical University Hospital (CMU107-ASIA-19, DMR-107-192, CRS-106-039, CRS-106-041). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study. The authors have no conflicts of interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

Author contributions: All authors have contributed substantially to, and are in agreement with the content of, the manuscript. Conception/design: C.-Y.L., C.-H.K. Provision of study materials: C.-H.K. Collection and/or assembly of data, data analysis and interpretation, manuscript preparation, and final approval of manuscript: all authors. The guarantor of the article, taking responsibility for the integrity of the work as a whole, from inception to published article: C.-H.K.

Correspondence to: Chia-Hung Kao, MD, Graduate Institute of Biomedical Sciences and School of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan. E-mail: d10040@mail.cmuh.org.tw; dr.kaochiahung@gmail.com.

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