68Ga-PSMA-11 PET and mpMRI in the diagnosis of initial lymph node staging of prostate cancer: a head-to-head comparative meta-analysis

Purpose This meta-analysis evaluates the comparative diagnostic efficacy of 68 Ga-prostate-specific membrane antigen-11 PET ( 68 Ga-PSMA-11 PET) and multiparametric MRI (mpMRI) for the initial lymph node staging of prostate cancer. Methods We searched PubMed and Embase databases through October 2023 for studies that provide a head-to-head comparison of 68 Ga-PSMA-11 PET and mpMRI, using pelvic lymph node dissection as the gold standard. We assessed sensitivity and specificity using the DerSimonian and Laird method, with variance stabilization via the Freeman-Tukey double inverse sine transformation. The quality of included studies was evaluated using the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool. Results The meta-analysis incorporated 13 articles, involving a total of 1,527 patients. 68 Ga-PSMA-11 PET demonstrated an overall sensitivity of 0.73 (95% CI: 0.51–0.91) and a specificity of 0.94 (95% CI: 0.88–0.99). In comparison, mpMRI showed a sensitivity of 0.49 (95% CI: 0.30–0.68) and a specificity of 0.94 (95% CI: 0.88–0.99). Although 68 Ga-PSMA-11 PET appeared to be more sensitive than mpMRI, the differences in sensitivity ( p = 0.11) and specificity ( p = 0.47) were not statistically significant. Conclusion Our findings indicated that 68 Ga-PSMA-11 PET and mpMRI exhibit similar sensitivity and specificity in the diagnosis of initial lymph node staging of prostate cancer. However, given that most included studies were retrospective, further prospective studies with larger sample sizes are essential to validate these results. Systematic Review Registration PROSPERO code is CRD42023495266.