Application of C-11-acetate positron-emission tomography (PET) imaging in prostate cancer: systematic review and meta-analysis of the literature

To review the literature on the application of (11) C-acetate positron-emission tomography (PET) imaging in prostate cancer. We systematically reviewed the available literature and presented the results in meta-analysis format. PubMed, SCOPUS, ISI web of knowledge, Science Direct, Springer, and Google Scholar were searched with 'Acetate AND PET AND Prostate' as keywords. All studies that evaluated accuracy of (11) C-acetate imaging in primary or recurrent prostate cancer were included, if enough data could be extracted for calculation of sensitivity and/or specificity. In all, 23 studies were included in the study. For evaluation of primary tumour, pooled sensitivity was 75.1 (69.8-79.8)% and specificity was 75.8 (72.4-78.9)%. For detection of recurrence, sensitivity was 64 (59-69)% and specificity was 93 (83-98)%. Sensitivity for recurrence detection was higher in post-surgical vs post-radiotherapy patients and in patients with PSA at relapse of >1 ng/mL. Studies using PET/computed tomography vs PET also showed higher sensitivity for detection of recurrence. Imaging with (11) C-acetate PET can be useful in patients with prostate cancer. This is especially true for evaluation of patients at PSA relapse, although the sensitivity is overall low. For primary tumour evaluation (localisation of tumour in the prostate and differentiation of malignant from benign lesions), (11) C-acetate is of limited value due to low sensitivity and specificity. Due to the poor quality of the included studies, the results should be interpreted with caution and further high-quality studies are needed.