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Comment & Response
May 2018

Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Locally Advanced, Recurrent, and Metastatic Prostate Cancer

Author Affiliations
  • 1Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
  • 2Peter MacCallum Cancer Centre, Division of Cancer Surgery, University of Melbourne, Melbourne, Victoria, Australia
JAMA Oncol. 2018;4(5):748-749. doi:10.1001/jamaoncol.2017.0287

To the Editor We read with great interest the recent article by Lindenberg et al.1 We commend the authors on a timely and comprehensive review in this important topic. However, there are several inconsistencies and inaccuracies that we believe necessitate clarification.

First, the authors highlight the naive nature of gallium citrate (68Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in current practice and discuss that histological validation is incomplete. However, in a recent meta-analysis published by our group,2,3 we identified 11 studies reporting histopathological correlation with 68Ga PSMA PET/CT. Of these, only 5 studies, representing 239 patients, were suitable for analysis due to the nature of the respective methodologies. From this, on per-patient–based analysis, the sensitivity, specificity, and positive and negative predictive value were 86%, 86%, 83%, and 89%, respectively. Similarly, on per-lesion–based analysis, the sensitivity, specificity, and positive and negative predictive values were 80%, 97%, 82%, and 97%, respectively. While more mature data are required to definitively determine the true sensitivity and specificity profile of 68Ga PSMA PET/CT, these meta-analytical data provide a useful indicator for clinicians. Furthermore, recent data correlating lymph node histopathologic analysis with PSMA PET/CT findings add further to the evidence base for PSMA PET/CT as the most promising of PET tracers in prostate cancer.