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<p>Active surveillance (AS) is a central management strategy for men with low-risk prostate cancer, aiming to avoid overtreatment while preserving the opportunity for curative intervention if progression occurs. A key challenge, however, is the accurate identification of clinically significant prostate cancer (csPCa) at baseline. Despite the integration of multiparametric MRI (mpMRI) and targeted biopsy into routine practice, biopsy-derived ISUP Grade Group 1 frequently underestimates true tumor grade, contributing to diagnostic uncertainty within AS pathways. Prostate-specific membrane antigen (PSMA) PET/CT has emerged as a potential complementary tool, supported by evidence linking PSMA expression with tumor aggressiveness. Ongoing prospective studies—PRIMARY2, CONFIRM and BiPASS—are evaluating whether PSMA PET can refine detection of csPCa, reduce false-negative biopsies and inform patient selection. However, existing PET-based assessment approaches were not specifically designed for AS, and their performance in post-biopsy, low-risk populations remain to be established. The Istanbul PSMA PET/CT Criteria (IPPC) were developed to provide a structured, reproducible method for categorizing intraprostatic PSMA uptake in men with ISUP Grade Group 1–2 disease being considered for AS. IPPC integrates morphological features, uptake intensity and delayed pelvic imaging to support risk stratification after biopsy. The ongoing I-SELECT study is designed to explore whether this framework can improve csPCa detection and guide AS decision-making in clinical practice.</p>

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[68Ga]Ga-PSMA PET/CT in active surveillance: From imaging to informed decision-making — a “Whistling Arrow” perspective

  • 期刊论文

  • 发表日期：

    2026年2月24日

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  • Levent Kabasakal

摘要

Active surveillance (AS) is a central management strategy for men with low-risk prostate cancer, aiming to avoid overtreatment while preserving the opportunity for curative intervention if progression occurs. A key challenge, however, is the accurate identification of clinically significant prostate cancer (csPCa) at baseline. Despite the integration of multiparametric MRI (mpMRI) and targeted biopsy into routine practice, biopsy-derived ISUP Grade Group 1 frequently underestimates true tumor grade, contributing to diagnostic uncertainty within AS pathways. Prostate-specific membrane antigen (PSMA) PET/CT has emerged as a potential complementary tool, supported by evidence linking PSMA expression with tumor aggressiveness. Ongoing prospective studies—PRIMARY2, CONFIRM and BiPASS—are evaluating whether PSMA PET can refine detection of csPCa, reduce false-negative biopsies and inform patient selection. However, existing PET-based assessment approaches were not specifically designed for AS, and their performance in post-biopsy, low-risk populations remain to be established. The Istanbul PSMA PET/CT Criteria (IPPC) were developed to provide a structured, reproducible method for categorizing intraprostatic PSMA uptake in men with ISUP Grade Group 1–2 disease being considered for AS. IPPC integrates morphological features, uptake intensity and delayed pelvic imaging to support risk stratification after biopsy. The ongoing I-SELECT study is designed to explore whether this framework can improve csPCa detection and guide AS decision-making in clinical practice.