PSMA-RADS 2.0: a revised framework for PSMA-targeted imaging interpretation and clinical decision-making

PSMA-RADS version 1, introduced by Rowe et al. in 2017, provides a framework for classifying PSMA-targeted PET scans and individual findings based on their likelihood of representing prostate cancer. The system was optimized for findings outside the prostate and was structured as a five-point scale (Rowe et al., Eur Urol 73:485-487, 2018. https://doi.org/10.1016/j.eururo.2017.10.027 . In 2022, an updated PSMA-RADS version was proposed to refine category definitions, address limitations of the initial version, and enhance its role in guiding clinical decisions. The framework includes both lesion-level and patient-level classifications, offering confidence and probability scores in support of clinical decision-making (Leung et al., EJNMMI Res. https://doi.org/10.1186/S13550-022-00948-1 ). This article aims to explore the changes introduced in the updated scale and evaluate their impact on clinical management. It is intended to inform abdominal and general radiologists about recent developments in PSMA-targeted imaging to support multidisciplinary collaboration and patient care.