Table 4.

Key findings of the systematic review and recommendations for future research purpose

Indication	Key findings	Recommended research
Overall	- heterogeneous study designs, definitions of outcome variables and imaging techniques - most studies were limited by insufficient sample size and low event rate with accordingly high level of uncertainty	- RCTs with adequate study sample and event rates - direct comparison between mpMRI and PET/CT with:    - standardized reporting (PIRADS, ESUR), clear definitions and same techniques    - blinding to clinical and pathological data    - central pathological and radiological review    - determination of different anatomical LN regions for LNI - external validation of models incorporating imaging results into existing tools - RCTs comparing different imaging modalities
EPE + SVI	- most studies reported on MRI - standardized reporting play an important role - reader experience and academic setting might improve performance - possible beneficial effect by adding imaging data to existing risk tools but no external validations so far
LNI	- PET seems more promising than MRI - size of lymph node metastases most important for detection among all modalities
M	- one RCT demonstrating superiority of PSMA-PET/CT to conventional staging, but:    - no blinding    - no comparisons between different imaging modalities - WB-MRI, NaF-PET/CT, FCH-PET/CT of unknown clinical utility	- first: RCTs evaluating role of WB-MRI, NaF- and FCH-PET/CT compared to conventional imaging - second: RCTs comparing different imaging modalities    - blinding of radiologists and physicians to clinical data    - central pathological and radiological review

Abbreviations:

EPE extraprostatic extension

SVI seminal vesicle invasion

LNI lymph node invasion

M distant metastases

RCT randomized controlled trial

PET/CT positron emission tomography/computed tomography

PSMA prostate specific membrane antigen

NaF 18F-Sodiumfluoride

FCH 18F-Fluorocholine

mp/WB-MRI multiparametric/whole body magnetic resonance imaging