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Updated: Aug 6, 2025
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MR Molecular Imaging of Prostate Cancer with a Small Molecular CLT1 Peptide Targeted Contrast Agent
Published on: September 3, 2013
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Second Version of the Prostate Cancer Molecular Imaging Standardized Evaluation Framework Including Response
Robert Seifert1, Louise Emmett2, Steven P Rowe3
1Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
European Urology
|March 19, 2023
Summary
The PROMISE V2 framework standardizes prostate-specific membrane antigen (PSMA) positron emission tomography (PET) reporting for prostate cancer staging and response assessment. This updated system improves communication and prognostic accuracy in clinical trials and routine practice.
Area of Science:
- Nuclear Medicine and Molecular Imaging
- Oncology and Urologic Oncology
- Radiopharmaceutical Therapy and Diagnostics
Background:
- Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) is a key imaging modality for prostate cancer staging and restaging.
- Standardized interpretation criteria are crucial for consistent reporting and clinical decision-making in PSMA-PET imaging.
- The Prostate cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria were previously proposed for whole-body staging.
Purpose of the Study:
- To develop a comprehensive and integrated framework for the interpretation and reporting of PSMA-PET imaging findings.
- To update and enhance the existing PROMISE criteria for improved clinical routine and research applications.
- To establish a standardized approach for response monitoring in clinical trials using PSMA-PET.
Main Methods:
- Development of the PROMISE V2 framework, incorporating an updated molecular imaging TNM (miTNM) staging system.
- Integration of improved assessment for local disease and a refined PSMA-expression score.
- Inclusion of a response monitoring framework with defined qualitative and quantitative parameters for longitudinal assessment in clinical trials.
Main Results:
- PROMISE V2 provides standardized reporting for disease extent in both clinical routine and research settings.
- PROMISE variables show a significant association with patient survival outcomes.
- A low PSMA-expression score is identified as a negative prognosticator for overall survival following 177Lu-PSMA radioligand therapy.
Conclusions:
- PROMISE V2 offers a standardized framework for reporting PSMA-PET findings, enhancing communication between imaging experts and uro-oncologists.
- The parameters established for response assessment in clinical trials enable objective evaluation of treatment efficacy.
- The framework supports current response evaluation criteria (e.g., PPP, RECIP) and facilitates the development of future criteria.
