Which Imaging is More Effective for Detecting Biochemical Recurrence of Prostate Cancer: PET/CT or mpMRI?

According to a recent meta-analysis, positron emission tomography/computed tomography (PET/CT) and multi-parameter magnetic resonance imaging (mpMRI) provide similar detection rates in diagnosing prostate cancer (PCa) recurrence.

The researchers found that prostate specific membrane antigen (PSMA) PET/CT had an overall detection rate of 69 percent for prostate cancer recurrence, compared to 70 percent for mpMRI.

“For [biochemical relapse], both approaches work. Our results show that there is no significant difference in overall DR (detection rate) between the two imaging modalities, and mpMRI is more cost-effective while maintaining the same DR, “wrote study co-author L. Xu, affiliated with the School of Medicine. Hunan University of Traditional Chinese Medicine, Hunan, China and colleagues.

For local PCa recurrence, the study authors noted that DR On mpMRI was 10% higher (62% vs. 52%). The researchers also found that PSMA PET/CT showed an 18% improvement in DR When diagnosing lymph node metastasis (50% and 32%, respectively). However, none of the findings were statistically significant, the study authors said.

The researchers believe that the high sensitivity and specificity may give PSMA PET/CT an advantage in PCa staging and detecting smaller lesions, but also acknowledge that the availability of the method is an issue. Multi-parameter MRI may be helpful in diagnosing local recurrence and clinically significant PCa, but the study authors acknowledge that interobserver heterogeneity may be an issue with mpMRI.

However, the overall results of the meta-analysis suggest that both approaches have a role in diagnosing PCa BCR, and point to future prospective studies that could provide greater clarity in this regard.

Xu and colleagues emphasized the substantial impact of the study’s results on clinical practice. They pointed out that the comparable diagnostic capabilities of PSMA PET/CT and mpMRI demonstrate the effectiveness of both methods in detecting BCR in PCa patients. However, they stressed the need for further research to evaluate the affordability, accessibility, and cost-effectiveness of these imaging techniques.

When discussing the study’s limitations, the authors admitted that the small sample size of 290 patients was a result of their focus on analyzing comparative studies for detecting BCR within the same patient groups. They also raised the possibility of bias in the results due to the diverse imaging protocols and patient characteristics across the six studies they reviewed.

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