Purpose: The aim of this study was to explore the diagnostic value of different fluorine-18 (18F)-labeled tracers for lymph node/bone metastasis and biochemical recurrence detection in advanced prostate cancer (PCa). Methods: PubMed, Embase, Web of Science, Cochrane databases, and the WHO International Clinical Trial Center were searched. The inclusion criteria were determined based on the Preferred Report Items of the Systematic Review and Meta-Analysis Guidelines. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the quality assessment of the included studies. The quantitative analysis of the included literature was performed on the patient and lesion basis, and the equivocal findings were considered negative or positive results, respectively. Results: Thirty-seven articles were included. On the patient basis, the pooled sensitivity and specificity of [18F]-labeled tracers were 0.80 (95% confidence interval [CI]: 0.78–0.83) and 0.89 (95% CI: 0.87–0.90) when equivocal results were considered to be positive and 0.80 (95% CI: 0.77–0.82) and 0.87 (95% CI: 0.85–0.89) when equivocal results were considered to be negative. On the lesion basis, the pooled sensitivity and specificity of [18F]-labeled tracers were 0.82 (95% CI: 0.80–0.83) and 0.91 (95% CI: 0.90–0.92) when equivocal lesions were regarded as positive and 0.81 (95% CI: 0.80–0.82) and 0.91 (95% CI: 0.90–0.92) when equivocal lesions were considered to be negative. Conclusion: [18F]-labeled tracers have high diagnostic efficacy for lymph node/bone metastasis and biochemical recurrence in advanced PCa.

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