Impact of PSMA PET on the management and clinical outcomes of patients with biochemical failure of prostate cancer after definitive treatment: a systematic review and meta-analysis.
Guoqing Zhu, Xingyu Xiong, Zhufeng Peng et al.
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In 30 seconds
This systematic review and meta-analysis assessed how PSMA PET affected management and clinical outcomes in men with biochemical failure of prostate cancer after definitive treatment. It included 71 studies comprising 9948 patients. Management changed after imaging in a pooled 53% of patients (95% CI: 48-58%), while serum PSA decreased in 75% (95% CI: 65-85%). Pooled biochemical recurrence-free and progression-free survival estimates were also reported at 1, 2, and 3 years. The authors considered the findings preliminary because of considerable heterogeneity and called for stronger prospective evidence.
Key findings
- Management changed following PSMA PET in a pooled 53% of patients (95% CI: 48-58%).
- Serum PSA decreased in 75% of patients (95% CI: 65-85%).
- Pooled 1-, 2-, and 3-year BRFS estimates were 62% (95% CI: 52-71%), 66% (95% CI: 55-77%), and 62% (95% CI: 46-78%).
- Pooled 1-, 2-, and 3-year BPFS estimates were 77% (95% CI: 65-88%), 84% (95% CI: 71-97%), and 79% (95% CI: 61-96%).
Why it matters
The findings indicate that PSMA PET frequently informs management in men with biochemical recurrence and that biochemical responses are observed in many patients receiving PET-guided care. The pooled survival estimates provide outcome context, but heterogeneity across studies limits confidence in interpreting these results as evidence of benefit attributable to imaging-guided management.
What to keep in mind
Considerable heterogeneity across included studies makes the conclusions preliminary; the authors state that more robust prospective evidence is needed.