Detection Rates of PSMA-PET Radiopharmaceuticals in Recurrent Prostate Cancer: A Systematic Review
<b>Background/Objectives</b>: To conduct a systematic review to evaluate the detection rates (DR) of the three FDA-approved PSMA-targeted radiopharmaceuticals in patients with recurrent prostate cancer. <b>Methods</b>: Two individuals systematically searched MEDLINE, ScienceD...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-05-01
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| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/10/1224 |
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| Summary: | <b>Background/Objectives</b>: To conduct a systematic review to evaluate the detection rates (DR) of the three FDA-approved PSMA-targeted radiopharmaceuticals in patients with recurrent prostate cancer. <b>Methods</b>: Two individuals systematically searched MEDLINE, ScienceDirect, and Cochrane Libraries (February 2025), and independently reviewed all results to identify studies reporting patient-level <sup>68</sup>Ga-PSMA-11, <sup>18</sup>F-DCFPyL, or <sup>18</sup>F-flotufolastat DR in ≥100 evaluable patients with recurrent prostate cancer. Sample-weighted means (SWM) of extracted DR were calculated. <b>Results</b>: Of 5059 published articles, 37 met our inclusion criteria, reporting data from 8843 patients undergoing <sup>68</sup>Ga-PSMA-11 (<i>n</i> = 27), <sup>18</sup>F-DCFPyL (<i>n</i> = 8), or <sup>18</sup>F-flotufolastat (<i>n</i> = 2) studies. Heterogeneity was noted across enrolled populations, particularly in prior treatments. <sup>68</sup>Ga-PSMA-11 studies recruited patients with marginally higher median PSA than <sup>18</sup>F-DCFPyL or <sup>18</sup>F-flotufolastat studies (median PSA ranged from 0.1 to 10.7, 0.2–2.5, and 0.6–1.1, respectively). Reported overall DR ranged from 25 to 91% for <sup>68</sup>Ga-PSMA-11, 49–86% for <sup>18</sup>F-DCFPyL, and 73–83% for <sup>18</sup>F-flotufolastat, with SWM of 71%, 66%, and 79%, respectively. Post-prostatectomy DR were reported in 18 articles, resulting in SWM DR of 58% for <sup>68</sup>Ga-PSMA-11 (<i>n</i> = 12), 55% for <sup>18</sup>F-DCFPyL (<i>n</i> = 4), and 76% for <sup>18</sup>F-flotufolastat (<i>n</i> = 2). Among post-radiotherapy patients, SWM were 87% for <sup>68</sup>Ga-PSMA-11 (<i>n</i> = 4), 90% for <sup>18</sup>F-DCFPyL (<i>n</i> = 2), and 99% for <sup>18</sup>F-flotufolastat (<i>n</i> = 1). SWM DR at PSA < 1 ng/mL were 53%, 42%, and 66% for <sup>68</sup>Ga-PSMA-11 (<i>n</i> = 13), <sup>18</sup>F-DCFPyL (<i>n</i> = 5), and <sup>18</sup>F-flotufolastat (<i>n</i> = 2), respectively. <b>Conclusions</b>: Considerable heterogeneity exists across populations in studies of diagnostic PET radiopharmaceuticals. Despite a paucity of <sup>18</sup>F-DCFPyL and <sup>18</sup>F-flotufolastat studies compared with <sup>68</sup>Ga-PSMA-11, the available data suggest that all three radiopharmaceuticals provide high overall DR in patients with biochemical recurrence of prostate cancer. |
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| ISSN: | 2075-4418 |