Impact of PSMA PET on the management and clinical outcomes of patients with biochemical failure of prostate cancer after definitive treatment: a systematic review and meta-analysis.

[PURPOSE] Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is emerging as an imaging modality with an established role for assessment of prostate cancer. This review aims to evaluate the impact of PSMA PET on the management and clinical outcomes in men with biochemical failure of prostate cancer.

[METHODS] We conducted a comprehensive literature search of the electronic databases from inception to August, 2025. The outcomes of interest included prostate-specific antigen (PSA) responses, biochemical recurrence-free survival (BRFS), biochemical progression-free survival (BPFS), and overall survival (OS). Meta-regression and subgroup analyses were conducted to explore the heterogeneity. Sensitivity analysis was performed to assess the robustness of the results.

[RESULTS] A total of 71 studies comprising 9948 patients were included in this systematic review and meta-analysis. The pooled proportion of patients experiencing a management change following PSMA PET was 53% (95% CI: 48-58%). A decrease in serum PSA level was observed in 75% (95% CI: 65-85%) of patients. For survival outcomes, the pooled estimates for 1-, 2-, and 3-year biochemical recurrence-free survival (BRFS) were 62% (95% CI: 52-71%), 66% (95% CI: 55-77%), and 62% (95% CI: 46-78%), respectively. The corresponding estimates for biochemical progression-free survival (BPFS) were 77% (95% CI: 65-88%), 84% (95% CI: 71-97%), and 79% (95% CI: 61-96%), respectively.

[CONCLUSIONS] This meta-analysis suggests that PSMA PET-guided management is associated with favorable oncologic outcomes in men with biochemical recurrence, with over half of patients experiencing a change in management strategy and a substantial proportion demonstrating a biochemical response. Nevertheless, due to considerable heterogeneity across studies, these conclusions remain preliminary and require confirmation through more robust prospective evidence.