The Diagnostic Role of (18)F-Choline, (18)F-Fluciclovine and (18)F-PSMA PET/CT in the Detection of Prostate Cancer With Biochemical Recurrence: A Meta-Analysis

BACKGROUND: Diagnosing the biochemical recurrence (BCR) of prostate cancer (PCa) is a clinical challenge, and early detection of BCR can help patients receive optimal treatment. We conducted a meta-analysis to define the diagnostic accuracy of PET/CT using (18)F-labeled choline, fluciclovine, and prostate-specific membrane antigen (PSMA) in patients with BCR. METHODS: Multiple databases were searched until March 30, 2021. We included studies investigating the diagnostic accuracy of (18)F-choline, (18)F-fluciclovine, and (18)F-PSMA PET/CT in patients with BCR. The pooled sensitivity, specificity, and detection rate of (18)F-labeled tracers were calculated with a random-effects model. RESULTS: A total of 46 studies met the included criteria; 17, 16, and 13 studies focused on (18)F-choline, fluciclovine, and PSMA, respectively. The pooled sensitivities of (18)F-choline and (18)F-fluciclovine were 0.93 (95% CI, 0.85–0.98) and 0.80 (95% CI, 0.65–0.897), and the specificities were 0.91 (95% CI, 0.73–0.97) and 0.66 (95% CI, 0.50–0.79), respectively. The pooled detection rates of (18)F-labeled choline, fluciclovine and PSMA were 66, 74, and 83%, respectively. Moreover, the detection rates of (18)F-labeled choline, fluciclovine, and PSMA were 35, 23, and 58% for a PSA level less than 0.5 ng/ml; 41, 46, and 75% for a PSA level of 0.5–0.99 ng/ml; 62, 57, and 86% for a PSA level of 1.0–1.99 ng/ml; 80, 92, and 94% for a PSA level more than 2.0 ng/ml. CONCLUSION: These three (18)F-labeled tracers are promising for detecting BCR in prostate cancer patients, with (18)F-choline showing superior diagnostic accuracy. In addition, the much higher detection rates of (18)F-PSMA showed its superiority over other tracers, particularly in low PSA levels. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier CRD42020212531.