Ziel/Aim A number of radiotracers are available for the staging of recurrent prostate cancer
(PC) with limited evidence directly comparing them. While a number of meta-analyses
are available in the literature, none use a networked approach which allows the inclusion
of indirect data. The objective was to perform a systematic review and networked meta-analysis
(NMA) to compare the detection rate for radiotracers in prostate cancer (PC) in order
to inform clinical practice and to facilitate the optimal choice of radiotracer.
Methodik/Methods The PUBMED and EMBASE databases were searched using the PRISMA-NMA statement using
a Boolean search string for any head-to-head comparison of 13 radiotracers of principal
interest: 18F-PSMA-1007, 18F-DCPFyl, 68Ga-PSMA-11, 18F-PSMA-11, 68Ga-PSMA-I&T, 68Ga-THP-PSMA, 64Cu-PSMA-617, 18F-JK-PSMA-7, 18F-Fluciclovine, 18F-FABC, 18F-Choline, 11C-Choline and 68Ga-RM2. Study quality was assessed by the QUADAS-2 tool. In total 166 studies were
screened, 44 studies analysed, 12 included for qualitative synthesis, and 12 included
for quantitative analysis. A network meta-analysis was performed using Markov-Chain
Monte-Carlo Bayesian analysis to obtain estimated detection rate ratios for each tracer
combination.
Ergebnisse/Results The systematic review identified 12 relevant studies including 1356 patients with
8 radiotracers. A majority of studies were judged to be a risk of publication bias.
With the exception of 18F-PSMA-1007, little difference in terms of detection rate was revealed between the
three most commonly used PSMA-radiotracers (68Ga-PSMA-11, 18F-PSMA-1007, 18F-DCFPyl), which in turn showed clear superiority to Choline and Fluciclovine using
the derived network.
Schlussfolgerungen/Conclusions Differences in patient-level detection rates were observed between PSMA- and choline-radiotracers.
However, there is currently insufficient evidence to favour one of the four routinely
used PSMA-radiotracers over another owing to the limited evidence base and risk of
publication bias revealed by our systematic review. The NMA derived can be used to
inform the design of future clinical trials and highlight areas where current evidence
is weak.
