PSMA-RADS to improve evaluation and management of prostate cancer

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.