Head-to-Head Comparison of (68)Ga-PSMA-11 PET/CT and Multiparametric MRI for Pelvic Lymph Node Staging Prior to Radical Prostatectomy in Patients With Intermediate to High-Risk Prostate Cancer: A Meta-Analysis

PURPOSE: To compare the diagnostic performance of (68)Ga-PSMA-11 PET/CT and mpMRI for pelvic lymph node staging prior to radical prostatectomy in prostate cancer (PCa) patients based on per patient data. METHODS: PubMed and Embase databases were searched until October 2020 for eligible studies evaluating head-to-head comparison of (68)Ga-PSMA-PET/CT and mpMRI for the detection of pelvic lymph node metastases (PLNMs) using pelvic lymph node dissection (PLND) as gold standard. The pooled sensitivity, specificity, and area under the summary receiver-operating characteristics curve (AUC) were determined for the two imaging modalities. RESULTS: Nine studies with 640 patients were included. The pooled sensitivity, specificity, and AUC for (68)Ga-PSMA-11 PET/CT vs. mpMRI were 0.71 (95% CI: 0.48–0.86) vs. 0.40 (95% CI: 0.16–0.71), 0.92 (95% CI: 0.88–0.95) vs. 0.92 (95% CI: 0.80–0.97), and 0.92 (95% CI: 0.88–0.95) vs. 0.82 (95% CI: 0.79–0.86), respectively. There was substantial heterogeneity for both imaging modalities, and meta-regression analysis revealed that the number of patients, prevalence of PLNMs, PSA level, reference standard, and risk classification might be the potential causes of heterogeneity. CONCLUSION: This meta-analysis of head-to-head comparison studies confirms that there is a trend toward a higher sensitivity and diagnostic accuracy of (68)Ga-PSMA-11 PET/CT compared to mpMRI for the detection of PLNMs in PCa patients. Nevertheless, according to current guidelines, PLND still needs to be recommended in case of negative results from (68)Ga-PSMA-11 PET/CT due to significant risk of malignancy.