Comparative diagnostic accuracy of PSMA-PET versus conventional imaging for Initial T/N/M staging of intermediate- to high-risk prostate cancer: a patient-level paired bivariate meta-analysis
Year: 2026
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Purpose Currently, the clinical value of prostate-specific membrane antigen-ligand positron emission tomography (PSMA-PET) in the diagnosis and initial staging of prostate cancer patients has gained clinical recognition. However, previous assessments have predominantly provided general overviews, lacking updated systematic evidence derived from direct comparative studies. Our study aims to synthesize the existing literature to perform a head-to-head comparison of the diagnostic efficacy between PSMA-PET and conventional imaging modalities in initial staging, using histopathology as the reference standard. These conventional methods include multiparametric magnetic resonance imaging (mpMRI), computed tomography (CT), and bone scintigraphy (BS), with comparisons encompassing primary tumor (T stage), regional lymph nodes (N stage), and distant bone metastases (M stage). Methods We conducted a systematic search from inception to October 2025 across PubMed, Embase, Web of Science, and Scopus databases using predefined search terms, including "PSMA PET," "primary staging," and "prostate cancer." Subsequently, two independent reviewers evaluated all studies against predetermined eligibility criteria, extracted relevant data, and assessed the quality of evidence. Any discrepancies were resolved by a third reviewer. Only studies in which patients underwent both PSMA-PET and conventional imaging modalities (CIM) with imaging findings validated against histopathology or a composite reference standard were included. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist and its comparative review extension (QUADAS-C). Statistical analysis was conducted using the bivariate composite likelihood (CL) method, with imaging modality incorporated as a covariate in the meta-regression model; statistical significance was determined using the likelihood ratio test. Results A total of 43 articles comprising 4,023 patients were included in this study. Our findings demonstrated that, compared with mpMRI, PSMA PET/CT and PSMA PET/MRI exhibited sensitivities of 51.6% versus 59.2% and 63.1% versus 51.0%, respectively, and specificities of 69.1% versus 76.1% and 74.1% versus 79.0%, respectively, for extraprostatic extension (EPE). For seminal vesicle invasion (SVI), the sensitivities were 53.6% versus 51.4% and 54.8% versus 48.3%, respectively, with specificities of 87.2% versus 91.1% and 94.3% versus 96.1%, respectively. Regarding lymph node staging, PSMA-PET demonstrated superior sensitivity and specificity compared with both mpMRI (69.9% versus 39.4%, 90.4% versus 88.5%) and CT (66.1% versus 35.1%, 97.2% versus 78.2%). For bone metastases, PSMA-PET exhibited significantly higher sensitivity and specificity regardless of whether single-photon emission computed tomography was concurrently employed (95.8% versus 76.2%, 92.8% versus 77.4%). Post-hoc subgroup analyses identified PSMA-PET scanner type and time interval exceeding one month as sources of heterogeneity. Sensitivity analyses further indicated that MRI magnetic field strength represented a potential influencing factor. Conclusions This study demonstrates that although PSMA-PET currently shows comparable performance to guideline-recommended multiparametric magnetic resonance imaging (mpMRI) for intraprostatic tumor local staging, its significantly superior diagnostic performance in lymph node and bone metastasis staging supports its use as the preferred method for initial staging of prostate cancer (PCa). Furthermore, we found that PSMA-PET/MRI exhibited higher sensitivity in detecting extraprostatic extension (EPE), providing a reference basis for optimizing local staging strategies in prostate cancer.
Source: BMC Cancer
Institutions: Sichuan University, West China Hospital of Sichuan University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,390
OpenAlex ID: W7171500834