AUTHOR=Belbina Safiya-Hana , Schmolze Mia Rose , Gereta Sofia , Laviana Aaron A. 

TITLE=PSMA as a Target for Advanced Prostate Cancer: A Systematic Review

JOURNAL=Frontiers in Urology

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/urology/articles/10.3389/fruro.2022.912558

DOI=10.3389/fruro.2022.912558

ISSN=2673-9828

ABSTRACT=Objective:  Prostate-specific membrane antigen (PSMA) is a cell-surface protein widely expressed on most prostate cancer cells that has rapidly emerging clinical utility in the realm of prostate cancer. This systematic review aims to evaluate the efficacy as well as cost-effectiveness of PSMA in the roles of diagnosis and treatment in prostate cancer management.

Background: The use of PSMA in the initial staging of patients, early detection of recurrence, and response monitoring are critical to improving prostate cancer treatment. We performed a systematic review of the role of Gallium-68 (68Ga)-PSMA in the initial detection of prostate cancer and detection of biochemical recurrence (BCR) as well as the role of Lutium-177 (177Lu)-PSMA in theranostics. We also investigated the cost-effectiveness of both ligands in comparison to the current standard of care.

Methods: In February 2022 we performed a systematic and comprehensive review of the literature. We identified and screened articles published from 1983 up to January 2022 through PubMed. We included articles that investigated the efficacy or cost-effectiveness of PSMA in prostate cancer detection and therapy. Eligible articles were selected, and relevant information was extracted from the original articles.

Results: A total of 28  articles were included in the analysis of this systematic review with 19 studies evaluating the role of PSMA in prostate cancer.  These studies were heterogeneous and were comprised of five prospective studies including 1,407 patients, one retrospective analysis of 191 patients, six systematic reviews, three meta-analyses, and four cost analyses. 

Conclusion: The diagnostic and therapeutic role of PSMA appears more efficacious and potentially less expensive than the standard treatment for patients with BCR of prostate cancer. Current evidence suggests PSMA will also fill an unmet need in initial diagnostics of prostate cancer and ligand therapy. However, a consensus has not yet been reached on cost-effectiveness and further prospective studies are needed.