Diagnostic accuracy of MRI and PSMA PET/CT for detection of histologically confirmed lymph node metastasis…

Meta-analysisArchivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica· Aug 2026

Diagnostic accuracy of MRI and PSMA PET/CT for detection of histologically confirmed lymph node metastasis in prostate cancer: A systematic review.

Emeka Ihechi Udeh, Solomon Anyimba, Loius Okolie … Maureen Udeh

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TheranosticsMeta-analysisDiagnosis

PSMA PET/CT more sensitive than MRI for detecting pelvic lymph node metastases in prostate cancer

Diagnostic accuracy of MRI and PSMA PET/CT for detection of histologically confirmed lymph node metastasis in prostate cancer: A systematic review.

Emeka Ihechi Udeh … Maureen Udeh

Archivio italiano di urologia, andrologia · Aug 2026

Purpose

To compare the diagnostic accuracy of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI) for the detection of histologically confirmed pelvic lymph node metastases in patients with intermediate- and high-risk prostate cancer.

Methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines.

n = 1,999 patients

Results

PSMA PET/CT caught just over half of true nodal metastases, missing many

54.6%

Sensitivity

92.7%

Specificity

More results

Sixteen studies comprising 1,999 patients met the inclusion criteria.

The hierarchical summary receiver operating characteristic area under the curve (AUC) was 0.909.

For mpMRI, pooled sensitivity was 33.0% (95% CI 18.7-51.3%) and pooled specificity was 94.9% (95% CI 92.2-96.8%), with an hierarchical summary receiver operating characteristic AUC of 0.941.

More results

Indirect comparison of pooled estimates suggested that PSMA PET/CT had higher sensitivity and a higher diagnostic odds ratio than mpMRI.

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Conclusion · 1 of 3

PSMA PET/CT demonstrated higher pooled sensitivity than mpMRI while maintaining similarly high specificity for detecting pelvic lymph node metastases.

Conclusion · 2 of 3

However, the moderate sensitivity of both imaging modalities indicates that a negative PSMA PET/CT scan cannot reliably exclude microscopic nodal disease.

Conclusion · 3 of 3

Furthermore, this comparison between pooled estimates should be interpreted with caution because it is based on an indirect comparison rather than a formal head-to-head meta-analysis.

Diagnostic accuracy of MRI and PSMA PET/CT for detection of histologically confirmed lymph node metastasis in prostate cancer: A systematic review.

Diagnostic accuracy of MRI and PSMA PET/CT for detection of histologically confirmed lymph node metastasis in prostate cancer: A systematic review.

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