Prostate specific membrane antigen focal ablation imaging (PSMA-FAB).

Area of Science:

• Oncology
• Radiology
• Nuclear Medicine

Background:

• Focal therapy is an emerging treatment for prostate cancer.
• Multiparametric MRI (mpMRI) is used to assess treatment response.
• Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is increasingly utilized in prostate cancer management.

Purpose of the Study:

• To introduce a novel scoring system, PSMA Focal Ablation Imaging (PSMA-FAB), for evaluating prostate cancer after focal therapy.
• To integrate PSMA PET/CT imaging into the assessment of treatment response.
• To propose a combined scoring system (FIRE-SCORE) for improved patient management.

Main Methods:

• Development of the PSMA-FAB scoring system based on pre- and post-treatment PSMA PET/CT imaging.
• Categorization of findings into PSMA-FAB 1, 2, and 3 based on imaging appearance.
• Proposal of a combined Focal-therapy Imaging Response Evaluation Score (FIRE-SCORE) incorporating PI-FAB and PSMA-FAB.

Main Results:

• The PSMA-FAB system categorizes findings into three levels: monitoring, assessment with potential biopsy, or recommended biopsy.
• The proposed system aims to standardize the interpretation of post-focal therapy imaging.
• A combined FIRE-SCORE is suggested to enhance follow-up decision-making.

Conclusions:

• The PSMA-FAB scoring system offers a standardized approach for assessing prostate cancer focal therapy response using PSMA PET/CT.
• This system, along with the FIRE-SCORE, can aid clinicians in managing patients post-treatment.
• Further validation is needed to establish the clinical utility of these scoring systems.