Comparison of Multiparametric MRI and the Combination of PSMA Plus MRI for the Intraprostatic Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis.

ABSTRACT

PURPOSE: The aim of this study was to perform a head-to-head comparison of multiparametric MRI (mpMRI) and the combination of prostate-specific membrane antigen (PSMA) PET plus MRI (PSMA + MRI) for detecting intraprostatic clinically significant prostate cancer (csPCa). PATIENTS AND METHODS: Relevant databases were searched through November 2023. Only studies directly comparing mpMRI and PSMA + MRI (PET/MRI or PET/CT + mpMRI) were included. A meta-analysis with a random-effects model was used to estimate pooled sensitivity, specificity, and area under the curve for each approach. RESULTS: A total of 19 studies were included. On a patient-level analysis, PSMA + MRI had higher sensitivity (9 studies) than mpMRI for csPCa detection (96% [95% confidence interval (CI) 92%, 98%] vs 89% [95% CI 81%, 94%]; P = 0.04). The patient-level specificity (4 studies) of PSMA + MRI was 55% (95% CI 31%-76%) compared with 50% (95% CI 44%-57%) of mpMRI ( P = 0.67). Region-level sensitivity (10 studies) was 85% (95% CI 74%-92%) for PSMA + MRI and 71% (95% CI 58%-82%) for mpMRI ( P = 0.09), whereas specificity (4 studies) was 87% (95% CI 76%-94%) and 90% (95% CI 82%-95%), respectively ( P = 0.59). Lesion-level sensitivity and specificity were similar between modalities with pooled data from less than 4 studies. CONCLUSIONS: PSMA + MRI had superior pooled sensitivity and similar specificity for the detection of csPCa compared with mpMRI in this meta-analysis of head-to-head studies.