Head-to-Head Comparison of Standardized Framework Systems for PSMA PET/CT for Evaluating PCa
| Standardized framework system | Advantages | Limitations |
| EANM consensus paper (21) | Is a consensus strategy for validation: after initial introduction, system has been validated by different sites and further improved in Delphi consensus settingProvides detailed evaluation and criteria for uncertain findingsWithout having a scale, demonstrated moderate consensus among experts and, thus, emphasizes importance of incorporating scalability in structured reporting systems | Lacks visual criteria scale, e.g., based on internal organ uptake as referenceDoes not include treatment recommendations for PSMA-based endoradiotherapies |
| PSMA-RADS, version 1.0 (19) | Considers site of disease and intensity of radiotracer uptake on 5-point scale, which may be easy to memorize | Needs further definition of terms such as typical or atypical for PCa in follow-up version (39) |
| Is part of MI-RADS; i.e., imaging interpreters who are familiar with PSMA-RADS should be able to learn SSTR-RADS (22,23) | Needs overall PSMA-RADS score definition, similar to SSTR-RADS (22) | |
| May be useful to guide reader in interpreting confusing false-positive or -negative discoveries, e.g., potential nonprostatic malignancies or benign findings mimicking PCa (25) | Lacks visual criteria scale, e.g., based on internal organ uptake as reference | |
| Provides clinical recommendations based on PSMA-RADS scoring (e.g., PSMA-RADS-3 triggers further work-up) (39) | Does not include treatment recommendations for PSMA-based endoradiotherapies | |
| Has been further validated in long-term follow-up study investigating indeterminate PSMA-RADS-3A and -3B lesions (26) | Has arbitrary initial definitions and needs further validation, e.g., by comparison of PSMA-RADS classification with histologic specimen or outcome assessments | |
| Demonstrated high interobserver agreement, even among inexperienced readers (27) | ||
| PROMISE (20) | Considers anatomic details, e.g., tumor location on sextant basisProvides visual criteria scale (miPSMA expression score) based on reference organsInitially invented with intention to be applicable to both PET/CT and PET/MRIHas variety of included details that may pave way for incorporation in large clinical trials, in which numerous parameters are needed to enrich datasetWas tested in vivo in PCa murine model and, thus, could potentially be applied in other preclinical settings (40) | Needs further validation, e.g., interobserver agreement studies and histopathologic comparisonsHas a threshold sensitivity that may affect miPSMA expression score (39)Does not include treatment recommendations for PSMA-based endoradiotherapies |