A Systematic Review on Artificial Intelligence Evaluating Metastatic Prostatic Cancer and Lymph Nodes on PSMA PET Scans.

Simple Summary: This systematic review demonstrated that artificial intelligence (AI) can help detect metastatic prostate cancer with or without lymph node involvement on prostate-specific membrane antigen (PSMA) PET scans with high accuracy. Additional benefits of AI include the ability to estimate the volume of metastatic cancer, prognosticate, and differentiate bony metastasis from post-radiotherapy bone changes. AI can also improve workflow by helping to standardize reporting and automate time-consuming tasks. However, given the variable sensitivity and positive predictive value of AI, it is recommended that an experienced nuclear medicine physician proofread the final report. Larger studies producing more consistent results are needed before AI can be fully integrated into PSMA reporting. Early detection of metastatic prostate cancer (mPCa) is crucial. Whilst the prostate-specific membrane antigen (PSMA) PET scan has high diagnostic accuracy, it suffers from inter-reader variability, and the time-consuming reporting process. This systematic review was registered on PROSPERO (ID CRD42023456044) and aims to evaluate AI's ability to enhance reporting, diagnostics, and predictive capabilities for mPCa on PSMA PET scans. Inclusion criteria covered studies using AI to evaluate mPCa on PSMA PET, excluding non-PSMA tracers. A search was conducted on Medline, Embase, and Scopus from inception to July 2023. After screening 249 studies, 11 remained eligible for inclusion. Due to the heterogeneity of studies, meta-analysis was precluded. The prediction model risk of bias assessment tool (PROBAST) indicated a low overall risk of bias in ten studies, though only one incorporated clinical parameters (such as age, and Gleason score). AI demonstrated a high accuracy (98%) in identifying lymph node involvement and metastatic disease, albeit with sensitivity variation (62–97%). Advantages included distinguishing bone lesions, estimating tumour burden, predicting treatment response, and automating tasks accurately. In conclusion, AI showcases promising capabilities in enhancing the diagnostic potential of PSMA PET scans for mPCa, addressing current limitations in efficiency and variability. [ABSTRACT FROM AUTHOR]