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Meta-Analysis Assesses Impact of PSMA PET/CT for Staging of Renal Cell Carcinoma


PSMA PET/CT demonstrated an 83 percent pooled detection rate for primary or metastatic renal cell carcinoma (RCC), and an 87 percent detection rate for restaging of metastatic or recurrent RCC, according to a nine-study meta-analysis.

For patients with renal cell carcinoma (RCC), a new meta-analysis suggests that prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) may play a viable role in assessing primary RCC as well as the staging of metastatic or recurrent RCC.

For the meta-analysis, recently published in the Journal of Nuclear Medicine, researchers reviewed data from nine studies and a total of 152 patients with RCC, including 133 patients with clear cell renal cell carcinoma (ccRCC).

Overall, the researchers found an 83 percent pooled lesion-level rate for detecting RCC with PSMA PET/CT. Based on results from three of the reviewed studies, PSMA PET/CT had a 74 percent pooled detection rate for primary RCC lesions, according to the meta-analysis authors. However, they also pointed out an 87 percent pooled lesion detection rate for the restaging of metastatic or recurrent RCC, based on results from seven of the reviewed studies.

Meta-Analysis Assesses Impact of PSMA PET/CT for Staging of Renal Cell Carcinoma

Here one can see PSMA PET/CT imaging revealing a 30 mm right lower pole lesion as well as additional sites of metastasis in a 60-year-old male patient. A new meta-analysis demonstrated that PSMA PET/CT had an 87 percent pooled lesion detection rate for restaging of metastatic or recurrent renal cell carcinoma. (Images courtesy of European Urology Focus.)

“Although our findings are based on small-scale studies with high heterogeneity, the preliminary results suggest merit in the use of PSMA PET/CT in RCC, particularly when performed for restaging of metastatic or recurrent disease,” wrote Moe S. Sadaghiani, M.D., who is affiliated with the Russell H. Morgan Department of Radiology and Radiological Sciences at Johns Hopkins University School of Medicine in Baltimore, and colleagues.

The reviewed studies included the use of radiotracer agents such as 18F-DCFPyL, 18F-PSMA-1007, 68Ga-PSMA-11, and 68Ga-P16–093 PET/CT, according to the meta-analysis.

Based on results from five studies (and data from 75 total patients), the researchers noted a pooled detection rate of 85 percent for metastatic RCC with 68Ga-based PSMA radiotracers. In two other studies comparing the use of 18F-DCFPyL PET/CT to conventional imaging with CT or MRI for metastatic ccRCC, the meta-analysis authors found that 18F-DCFPyL PET/CT offered a nearly 30 percent higher detection rate (92 percent vs. 63 percent).

“Analysis based on the type of radiotracer showed a pooled detection rate of 0.85 for 68Ga-based PSMA tracers and 0.92 for 18F-DCFPyL PET/CT. Furthermore, in metastatic ccRCC, the available data support a significantly higher detection rate for 18F-DCFPyL PET/CT than for conventional imaging modalities,” added Sadaghiani and colleagues.

In regard to limitations with the meta-analysis, the authors acknowledged the small number of total patients (152) and the retrospective design of most of the reviewed studies. They also noted heterogeneity with the studies, citing varied indications for utilizing PSMA PET.CT and a lack of information on lesion size and location for patients with RCC.

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