Efficacy of [ ¹⁸ F]PSMA-1007 PET/CT in Primary Staging of Prostate Carcinoma: A Systematic Review and Metaanalysis

Staging of prostate carcinoma (PCa) still largely relies on histopathologic examination of prostate tissue. In the last few years, PET/CT with radiotracers that target the prostate-specific membrane antigen (PSMA) has emerged as a noninvasive and sensitive method for staging of PCa. Compared with [⁶⁸Ga]PSMA-11, [¹⁸F]PSMA-1007 is a relatively new radiotracer for PSMA PET/CT with favorable characteristics such as a longer physical half-life, reduced bladder background uptake, and improved availability due to production off-site. The objective of this systematic review and metaanalysis is to summarize the efficacy of [¹⁸F]PSMA-1007 in primary T, N, and M staging of PCa in comparison to histopathology. <b>Methods:</b> Clinical trials on primary staging of PCa with [¹⁸F]PSMA-1007 (both prospective and retrospective studies) were identified by a systematic search in PubMed. Relevant literature used histopathology as a comparator and reported discrete values for sensitivity and specificity. A metaanalysis assessed differences in diagnostic parameters. <b>Results:</b> Nineteen studies were included in this review: 10 studies reported on T staging (739 patients), 8 studies reported on N staging (865 patients), and 1 study reported on M staging (79 patients). For T staging, our metaanalyses of extraprostatic extension on a patient level based on 3 studies revealed a pooled sensitivity of 54% (95% CI, 46%-63%) and a pooled specificity of 92% (95% CI, 76%-98%). For N staging, our metaanalyses on detection of lymph node metastases on a patient level based on 5 studies revealed a pooled sensitivity of 42% (95% CI, 28%-57%) and a pooled specificity of 94% (95% CI, 90%-97%). In terms of sensitivity for M staging on a patient level, [¹⁸F]PSMA-1007 PET/CT outperformed all other tested conventional imaging modalities. <b>Conclusion:</b> PET/CT imaging with [¹⁸F]PSMA-1007 provides high sensitivity and specificity in T, N, and M staging of PCa when compared with histopathology. It offers the possibility to perform noninvasive primary T, N, and M staging before treatment in a single procedure.