18F-labeled prostate-specific membrane antigen positron emission tomography/computed tomography vs. magnetic resonance imaging in diagnosis of prostate cancer A meta-analysis.

INTRODUCTION: The accurate diagnosis of prostate cancer remains a clinical challenge, with both multiparametric magnetic resonance imaging (mpMRI) and 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) emerging as important imaging modalities. This meta-analysis aimed to compare the diagnostic performance of 18F-PSMA PET/CT vs. MRI for detecting prostate cancer. METHODS: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines. Multiple databases were searched through February 2025. Studies comparing 18F-PSMA PET/CT with MRI for prostate cancer diagnosis using histopathology as the reference standard were included. Random-effects models were used to pool sensitivity data, with heterogeneity assessed using I2 statistics. RESULTS: Six studies comprising 310 patients were included. The pooled sensitivity for MRI was 0.81 (95% confidence interval [CI] 0.08-0.99) with substantial heterogeneity (I2=93.8%). For 18F-PSMA PET/CT, the overall sensitivity was 0.50 (95% CI 0.12-0.87) with high heterogeneity (I2=96.0%). Subgroup analysis showed 18F-PSMA PET had a pooled sensitivity of 0.50 (95% CI 0.12-0.87), while MRI demonstrated 0.81 (95% CI 0.42-0.96). No significant publication bias was detected. CONCLUSIONS: Both imaging modalities showed variable diagnostic performance across studies. The combination of PSMA PET/CT and MRI may provide complementary information for optimal prostate cancer detection, although substantial heterogeneity suggests the need for standardized protocols and larger prospective trials.