Detection rate of [99mTc]Tc-PSMA SPECT/CT in prostate cancer: a systematic review and a meta-analysis

Background/objective Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) remains a fundamental diagnostic tool for Prostate cancer (PCa), yet its use is frequently constrained by the high costs and infrastructure requirements of PET imaging. [ 99m Tc]Tc-PSMA single photon emission computed tomography/CT (SPECT/CT) emerges as a viable diagnostic option, showing significant potential in both the primary staging and restaging of prostate cancer. We performed a systematic review and meta-analysis about the detection rate (DR) of [ 99m Tc]Tc-PSMA SPECT/CT in PCa patients. Methods A comprehensive literature search of the PubMed/MEDLINE, Scopus, and Cochrane libraries was performed to extract relevant published articles about the DR of [ 99m Tc]Tc-PSMA SPECT/CT in patients affected by PCa. Results Twenty-three studies ( n = 1,840 patients) were included in the systematic review with 19 studies eligible for the meta-analysis. The pooled estimated DR of [ 99m Tc]Tc-PSMA SPECT/CT in the staging field was 79.7% (95% CI 70.2–89.3%); in restaging biochemical recurrence was 75.4% (95% CI 67.7–83%). A significant statistical heterogeneity was reported in both analyses. PSA value at the time of SPECT/CT was frequently associated with the DR. Conclusions In conclusion, our analysis showed that [ 99m Tc]Tc-PSMA SPECT/CT is a good diagnostic tool for prostate cancer, both at staging and biochemical recurrence. It may be useful as an alternative in resource-constrained environments or remote locations where PET/CT technology is not readily accessible.