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  • Review Article
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A systematic review and meta-analysis to evaluate the diagnostic accuracy of PSMA PET/CT in the initial staging of prostate cancer

Prostate Cancer and Prostatic Diseases volume 28, pages 56–69 (2025)Cite this article

Subjects

Abstract

Background

Positron Emission Tomography-Computed Tomography using Prostate-Specific Membrane Antigen (PSMA PET/CT) is notable for its superior sensitivity and specificity in detecting recurrent PCa and is under investigation for its potential in pre-treatment staging. Despite its established efficacy in nodal and metastasis staging in trial setting, its role in primary staging awaits fuller validation due to limited evidence on oncologic outcomes. This systematic review and meta-analysis aims to appraise the diagnostic accuracy of PSMA PET/CT compared to CI for comprehensive PCa staging.

Methods

Medline, Scopus and Web of science databases were searched till March 2023. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Primary outcomes were specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of PSMA PET/CT for local, nodal and metastatic staging in PCa patients. Due to the unavailability of data, a meta-analysis was feasible only for detection of seminal vesicles invasion (SVI) and LNI.

Results

A total of 49 studies, comprising 3876 patients, were included. Of these, 6 investigated accuracy of PSMA PET/CT in detection of SVI. Pooled sensitivity, specificity, PPV and NPV were 42.29% (95%CI: 29.85–55.78%), 87.59% (95%CI: 77.10%–93.67%), 93.39% (95%CI: 74.95%–98.52%) and 86.60% (95%CI: 58.83%–96.69%), respectively. Heterogeneity analysis revealed significant variability for PPV and NPV. 18 studies investigated PSMA PET/CT accuracy in detection of LNI. Aggregate sensitivity, specificity, PPV and NPV were 43.63% (95%CI: 34.19–53.56%), 85.55% (95%CI: 75.95%–91.74%), 67.47% (95%CI: 52.42%–79.6%) and 83.61% (95%CI: 79.19%–87.24%). No significant heterogeneity was found between studies.

Conclusions

The present systematic review and meta-analysis highlights PSMA PET-CT effectiveness in detecting SVI and its good accuracy in LNI compared to CI. Nonetheless, it also reveals a lack of high-quality research on its performance in clinical T staging, extraprostatic extension and distant metastasis evaluation, emphasizing the need for further rigorous studies.

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Fig. 1
Fig. 2: Forest plot depicting PSMA PET/CT performance in detecting seminal vesicle invasion.
Fig. 3: Forest plot depicting PSMA PET/CT performance in lymph node involvement.

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Data availability

The data presented in this study are available in this article and Supplementary Materials.

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Author information

Author notes

  1. These authors contributed equally: Andrea Mari, Anna Cadenar.

Authors and Affiliations

  1. Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy

    Andrea Mari, Anna Cadenar, Sofia Giudici, Gemma Cianchi, Fabrizio Di Maida & Andrea Minervini

  2. Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy

    Simone Albisinni

  3. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Riccardo Autorino

  4. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Giorgio Gandaglia

  5. Department of Urology, Hospital Universitario La Ribera, Valencia, Spain

    M. Carmen Mir

  6. Department of Urology, University Hospital of Geneva, Geneva, Switzerland

    Massimo Valerio

  7. Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy

    Giancarlo Marra

  8. Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy

    Fabio Zattoni

  9. Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Lorenzo Bianchi

  10. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Riccardo Lombardo & Cosimo De Nunzio

  11. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  12. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  13. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  14. Department of Urology, Weill Cornell Medical College, New York, NY, 10065, USA

    Shahrokh F. Shariat

  15. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

    Shahrokh F. Shariat

  16. European Association of Urology Research Foundation, Arnhem, The Netherlands

    Shahrokh F. Shariat

  17. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien

    Shahrokh F. Shariat

  18. Urology, Predictive Onco-Urology, AP-HP, Urology Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France

    Morgan Roupret

  19. Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Matteo Bauckneht

  20. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Matteo Bauckneht

  21. Nuclear Medicine Division, Careggi University Hospital, Florence, Italy

    Luca Vaggelli

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Contributions

AM and AC: Conceptualization, data analysis, original draft preparation; SG and GC: Data collection and curation; SA, RA, FDM, GG, MCM, MV, GM, FZ, LB, RL, SFS, MR, MB, LV: Manuscript revision and editing; CDM, AM: Supervision, conceptualization.

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Correspondence to Andrea Mari.

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Cosimo De Nunzio, Editor in Chief of prostate Cancer and Prostatic Disease.

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Mari, A., Cadenar, A., Giudici, S. et al. A systematic review and meta-analysis to evaluate the diagnostic accuracy of PSMA PET/CT in the initial staging of prostate cancer. Prostate Cancer Prostatic Dis 28, 56–69 (2025). https://doi.org/10.1038/s41391-024-00850-y

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