Navigating the Scoring Systems and Interpretation Frameworks of Prostate-specific Membrane Antigen PET

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Prostate-specific membrane antigen (PSMA) PET imaging offers superior sensitivity and specificity for prostate cancer staging and restaging compared to conventional methods.
• Interpretive challenges with PSMA PET led to the development of various scoring systems, impacting consistent analysis.

Purpose of the Study:

• To review and discuss current standardized interpretation and reporting systems for PSMA PET in prostate cancer.
• To evaluate the strengths and weaknesses of these systems in optimizing patient management and communication.

Main Methods:

• Review of established PSMA PET interpretation frameworks including PROMISE v2, PSMA-RADS, PPP criteria, RECIP 1.0, and EANM guidelines.
• Analysis of how these systems address local disease assessment, staging, therapy response evaluation, and treatment eligibility.

Main Results:

• PROMISE v2 integrates local staging, molecular TNM staging, and PSMA expression scoring.
• PSMA-RADS standardizes reporting based on cancer likelihood. Therapy response is assessed by PPP criteria and RECIP 1.0.
• EANM guidelines consolidate existing systems for standardized reporting.

Conclusions:

• Standardized PSMA PET interpretation systems are crucial for consistent prostate cancer management.
• These systems facilitate better communication among healthcare professionals and patients.
• Continued evaluation of these systems is necessary to refine their strengths and address weaknesses.