Application of 11C‐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 ¹¹C‐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 ¹¹C‐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 ¹¹C‐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), ¹¹C‐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.