前列腺特异性膜抗原（PSMA）是前列腺癌（PCa）中高表达的蛋白质，近年来已成为分子影像学的越来越受欢迎的靶点。基于PSMA的正电子发射计算机断层扫描/计算机断层扫描（PET/CT）是一种成熟的混合成像模式，结合了PET的高灵敏度和CT成像的高空间分辨率，为检测和管理PCa提供了准确的工具。最近发表了多项关于PSMA PET/CT在PCa诊断精度和临床管理方面的研究。本研究旨在进行一项更新的系统评价和荟萃分析，评估PSMA PET/CT在局部、淋巴结转移（LNM）和复发性PCa患者中的诊断表现，并评估其对原发性和复发性PCa的临床管理的影响。使用Medline、Embase、PubMed 和Cochrane图书馆数据库，根据PRISMA指南分析了报道PSMA PET/CT诊断精度和临床管理的研究。采用随机效应模型进行统计分析，并进行荟萃回归分析探讨观察到的异质性。结果表明，局部PCa的PSMA PET/CT灵敏度和特异度分别为71.0％（95％置信区间（CI）：58.0，81.0）和92.0％（95％CI：86.0，96.0）（N = 10; n = 404名患者）。 LNM的灵敏度和特异度分别为57.0％（95％CI：49.0，64.0）和96.0％（95％CI：95.0，97.0）（N = 36; n = 3，659名患者）。对于生化复发（BCR）的患者，灵敏度为84.0％（95％CI：74.0，90.0），特异度为97.0％（95％CI：88.0，99.0）（N = 9; n = 818名患者）。在原发性（N = 16; n = 1,099名患者）和复发性（N = 40; n = 5,398名患者）PCa中，管理变化的综合比例分别为28.0％（95％CI：23.0，34.0）和54.0％（95％CI：50.0，58.0）。总之，PSMA PET/CT在局部和LNM疾病中显示出中等灵敏度和高特异度，而在BCR患者中的准确性较高。PSMA PET/CT还对PCa患者的临床管理产生了重大影响。这是包括PCa三个亚组的最全面和首个系统性评价，诊断精度和临床管理变化在原发性和复发性疾病环境中分别得到了经过组织学验证的报告。版权所有© 2023 Elsevier Inc。保留所有权利。

Prostate-specific membrane antigen (PSMA) is a highly expressed protein in prostate cancer (PCa) and has become an increasingly popular target for molecular imaging in recent years. PSMA based positron-emission-tomography/computed tomography (PET/CT) is a well characterised hybrid imaging modality that combines the high sensitivity of PET with the high spatial resolution of CT imaging. The combination of these two imaging modalities provides an accurate tool for detecting and managing PCa. Several diagnostic accuracy and clinical management studies investigating the role of PSMA PET/CT in PCa have been published recently. This study aimed to perform an updated systematic review and meta-analysis to evaluate the diagnostic performance of PSMA PET/CT in localised, lymph node metastatic (LNM) and recurrent PCa patients and assess its impact on the clinical management of primary and recurrent PCa. Using Medline, Embase, PubMed and Cochrane Library databases, studies reporting the diagnostic accuracy and clinical management of PSMA PET/CT were analysed based on the PRISMA guidelines. Statistical analyses were conducted using random-effects models, and meta-regression explored observed heterogeneity. Results indicate that the sensitivity and specificity of PSMA PET/CT for localised PCa were 71.0% (95% confidence interval (CI): 58.0, 81.0) and 92.0% (95% CI: 86.0, 96.0), respectively (N = 10; n = 404 patients). Sensitivity and specificity in LNM were 57.0% (95% CI: 49.0, 64.0) and 96.0% (95% CI: 95.0, 97.0) (N = 36; n = 3,659 patients). For patients with biochemical recurrence (BCR), sensitivity was 84.0% (95% CI: 74.0, 90.0), and specificity was 97.0% (95% CI: 88.0, 99.0) (N = 9; n = 818 patients). The pooled proportion of management changes in primary (N = 16; n = 1,099 patients) and recurrent (N = 40; n = 5,398 patients) PCa was 28.0% (95% CI: 23.0, 34.0) and 54.0% (95% CI: 50.0, 58.0), respectively. In conclusion, PSMA PET/CT shows moderate sensitivity and high specificity in localised and LNM disease, while the accuracy in BCR patients was high. PSMA PET/CT also had a large impact on the clinical management of PCa patients. This is the most extensive and first systematic review to include three subgroups of PCa with histologically verified diagnostic accuracy and clinical management change reported separately in primary and recurrent disease settings.Copyright © 2023 Elsevier Inc. All rights reserved.