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PSMA-RADS to improve evaluation and management of prostate cancer

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Abstract

Prostate-Specific Membrane Antigen (PSMA) positron emission tomography (PET) / computed tomography (CT) has become essential in managing prostate cancer, offering superior diagnostic accuracy. The introduction of the U.S. Food and Drug Administration (FDA)-approved theranostic agent (177Lutetium-PSMA-617) has further enhanced the significance of PSMA PET/CT imaging. Despite its benefits, PSMA-PET/CT is not without challenges, as PSMA expression is not exclusive to prostate cancer cells. Therefore, standardized interpretation criteria are necessary for consistent and reliable communication among physicians. The PSMA- reporting and data system (RADS) provides a structured approach for assessing PSMA-PET/CT scans. Updated in 2023, PSMA-RADS 2.0 addresses previous limitations and introduces a new category, PSMA-RADS 5T, for treated metastases. This system categorizes lesions based on their likelihood of prostate cancer involvement, improving longitudinal monitoring and guiding management strategies. By familiarizing radiologists with PSMA-RADS through case-based reviews, this primer aims to enhance diagnostic accuracy and treatment planning for patients with prostate cancer.

Highlights

PSMA-RADS 2.0 enhances the diagnostic accuracy of PSMA-PET/CT scans.

PSMA-RADS 2.0 system is revised to include categories for a range of benign and malignant findings.

The system facilitates communication between molecular imaging and referring physicians by specifying which lesions require further work-up.

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Data availability

No datasets were generated or analysed during the current study.

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  1. University of California, Irvine, USA

    Niloufar Rafiei Alavi, Maryam Rahmani, Arti Gupta & Vahid Yaghmai

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N. R., M.R., and A. G. collected images N.R. and V.Y. drafted the initial manuscript. All authors reviewed the manuscript. All authors reviewed reviewer comments and helped in drafting responses and revisions.

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Correspondence to Vahid Yaghmai.

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Rafiei Alavi, N., Rahmani, M., Gupta, A. et al. PSMA-RADS to improve evaluation and management of prostate cancer. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04738-2

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