Abstract：
OBJECTIVE: Radiation therapy is used frequently for patients with prostate cancer. Dose escalation to intraprostatic lesions (IPLs) has been shown to improve oncologic outcomes, without increasing toxicity. Both multiparametric MRI (mpMRI) and PSMA PET can be used to identify IPLs.
METHODS: A systematic review was conducted to determine the ability of mpMRI, PSMA PET and their combination to detect IPLs prior to radical prostatectomy (RP) as correlated with the histology. Trials included patients that had mpMRI, PSMA PET, or both, prior to RP. The quality of the histopathological-radiological co-registration was assessed as high or low for each study. Recorded outcomes include sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). A meta-analysis was conducted using a bivariate model to determine the pooled sensitivity and specificity for each imaging modality. This systematic review was registered through PROSPERO (CRD42023389092).
RESULTS: Altogether, 42 studies were included in the systematic review. Of these, 20 could be included in the meta-analysis. The pooled sensitivity (95 % CI), specificity (95 % CI) and AUROC for mpMRI (n = 13 studies) were 64.7 % (50.2 % - 76.9 %), 86.4 % (79.7 % - 91.1 %), and 0.852; the pooled outcomes for PSMA PET (n = 12) were 75.7 % (64.0 % - 84.5 %), 87.1 % (80.2 % - 91.9 %), and 0.889; for their combination (n = 5), the pooled outcomes were 70.3 % (64.1 % - 75.9 %), 81.9 % (71.9 % - 88.8 %), and 0.796. When reviewing studies with a high-quality histopathological-radiological co-registration, IPL delineation recommendations varied by study and the imaging modality used.
CONCLUSIONS: All of mpMRI, PSMA PET or their combination were found to have very good diagnostic outcomes for detecting IPLs. Recommendations for delineating IPLs varied based on the imaging modalities used and between research groups. Consensus guidelines for IPL delineation would help with creating consistency for focal boost radiation treatments in future studies.
METHODS: A systematic review was conducted to determine the ability of mpMRI, PSMA PET and their combination to detect IPLs prior to radical prostatectomy (RP) as correlated with the histology. Trials included patients that had mpMRI, PSMA PET, or both, prior to RP. The quality of the histopathological-radiological co-registration was assessed as high or low for each study. Recorded outcomes include sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). A meta-analysis was conducted using a bivariate model to determine the pooled sensitivity and specificity for each imaging modality. This systematic review was registered through PROSPERO (CRD42023389092).
RESULTS: Altogether, 42 studies were included in the systematic review. Of these, 20 could be included in the meta-analysis. The pooled sensitivity (95 % CI), specificity (95 % CI) and AUROC for mpMRI (n = 13 studies) were 64.7 % (50.2 % - 76.9 %), 86.4 % (79.7 % - 91.1 %), and 0.852; the pooled outcomes for PSMA PET (n = 12) were 75.7 % (64.0 % - 84.5 %), 87.1 % (80.2 % - 91.9 %), and 0.889; for their combination (n = 5), the pooled outcomes were 70.3 % (64.1 % - 75.9 %), 81.9 % (71.9 % - 88.8 %), and 0.796. When reviewing studies with a high-quality histopathological-radiological co-registration, IPL delineation recommendations varied by study and the imaging modality used.
CONCLUSIONS: All of mpMRI, PSMA PET or their combination were found to have very good diagnostic outcomes for detecting IPLs. Recommendations for delineating IPLs varied based on the imaging modalities used and between research groups. Consensus guidelines for IPL delineation would help with creating consistency for focal boost radiation treatments in future studies.
摘要：
目的：前列腺癌患者经常使用放射治疗。前列腺内病变（IPL）的剂量递增已被证明可以改善肿瘤学结果，不增加毒性。多参数MRI（mpMRI）和PSMAPET均可用于识别IPL。
方法：进行了系统评价以确定mpMRI的能力，PSMAPET及其组合可在根治性前列腺切除术（RP）之前检测与组织学相关的IPL。试验包括接受过mpMRI的患者，PSMAPET,或者两者兼而有之,在RP之前。对于每个研究，组织病理学-放射学共配准的质量被评估为高或低。记录的结果包括敏感性，特异性，和受试者工作特征曲线下面积(AUROC)。使用双变量模型进行荟萃分析，以确定每种成像模式的合并敏感性和特异性。本系统综述通过PROSPERO(CRD42023389092)注册。
结果：总之，42项研究纳入系统评价。其中,20可以包括在荟萃分析中。合并敏感性(95%CI)，MPMRI的特异性（95%CI）和AUROC（n=13项研究）为64.7%（50.2%-76.9%），86.4%（79.7%-91.1%），和0.852；PSMAPET（n=12）的汇总结果为75.7％（64.0％-84.5％），87.1%（80.2%-91.9%），和0.889；对于它们的组合(n=5)，合并结果为70.3%(64.1%-75.9%)，81.9%（71.9%-88.8%），和0.796。在审查高质量的组织病理学-放射学联合登记的研究时，IPL轮廓的建议因研究和使用的成像方式而异。
结论：所有的mpMRI，发现PSMAPET或其组合对于检测IPL具有非常好的诊断结果。根据使用的成像方式和研究小组之间的不同，描绘IPL的建议有所不同。IPL划定的共识指南将有助于在未来的研究中为局灶性增强放射治疗创造一致性。
方法：进行了系统评价以确定mpMRI的能力，PSMAPET及其组合可在根治性前列腺切除术（RP）之前检测与组织学相关的IPL。试验包括接受过mpMRI的患者，PSMAPET,或者两者兼而有之,在RP之前。对于每个研究，组织病理学-放射学共配准的质量被评估为高或低。记录的结果包括敏感性，特异性，和受试者工作特征曲线下面积(AUROC)。使用双变量模型进行荟萃分析，以确定每种成像模式的合并敏感性和特异性。本系统综述通过PROSPERO(CRD42023389092)注册。
结果：总之，42项研究纳入系统评价。其中,20可以包括在荟萃分析中。合并敏感性(95%CI)，MPMRI的特异性（95%CI）和AUROC（n=13项研究）为64.7%（50.2%-76.9%），86.4%（79.7%-91.1%），和0.852；PSMAPET（n=12）的汇总结果为75.7％（64.0％-84.5％），87.1%（80.2%-91.9%），和0.889；对于它们的组合(n=5)，合并结果为70.3%(64.1%-75.9%)，81.9%（71.9%-88.8%），和0.796。在审查高质量的组织病理学-放射学联合登记的研究时，IPL轮廓的建议因研究和使用的成像方式而异。
结论：所有的mpMRI，发现PSMAPET或其组合对于检测IPL具有非常好的诊断结果。根据使用的成像方式和研究小组之间的不同，描绘IPL的建议有所不同。IPL划定的共识指南将有助于在未来的研究中为局灶性增强放射治疗创造一致性。
