# Interpretation of PSMA-PET Among Urologists: A Prospective Multicentric Evaluation

## TL;DR

Urologists struggle to accurately interpret PSMA-PET scans for prostate cancer staging, with only one out of 63 achieving full accuracy and high-volume centers showing better performance.

## Contribution

First study to evaluate urologists' PSMA-PET interpretation skills, highlighting the need for structured training and multidisciplinary collaboration.

## Key findings

- Only one urologist achieved full staging accuracy in PSMA-PET interpretation.
- High-volume centers and multidisciplinary teams showed better diagnostic performance.
- Structured training and collaboration are essential to improve staging accuracy.

## Abstract

This study evaluated how accurately urologists can interpret PSMA-PET scans for staging high-risk prostate cancer. Sixty-three urologists from eight Italian centers assessed 20 scans without clinical context. Results showed that interpretation is difficult: only one participant achieved full accuracy, and less than half reached an acceptable level for partial staging. Urologists from high-volume centers and those involved in multidisciplinary teams performed better, suggesting that experience and collaboration improve diagnostic skills. These findings underscore the importance of structured training and multidisciplinary exposure to enhance staging accuracy and ultimately improve patient outcomes.

Background: Prostate-specific membrane antigen (PSMA)-PET imaging has significantly improved prostate cancer (PCa) staging, yet its interpretation remains challenging, even for experienced specialists. No prior study has assessed urologists’ ability to interpret PSMA-PET. Methods: We conducted a multicenter prospective study involving 63 urologists from eight Italian institutions. Participants evaluated 20 PSMA-PET scans of high-risk PCa cases, with no clinical information provided. Proficiency was defined as correctly identifying at least two of three staging components (T, N, M) in ≥75% of cases. Associations between performance and factors such as hierarchy (resident vs. consultant), institution type, surgical volume, and multidisciplinary team (MDT) presence were analyzed using univariable and multivariable logistic regression. Results: Only one participant achieved full staging proficiency, while 44% reached the ≥75% threshold for partial (almost correct) staging. Urologists from centers with ≥300 PCa diagnoses per year demonstrated better T and M stage identification. Institutions with ≥150 robot-assisted radical prostatectomies (RARPs) per year and those with MDTs showed higher accuracy in M staging. No significant predictors of proficiency emerged in the multivariable analysis, although hierarchy and surgical volume approached significance for nodal metastasis detection. Conclusion: PSMA-PET interpretation is complex for urologists, with particular challenges in T and M staging. High institutional case volumes and MDT involvement may enhance interpretation skills. Structured training programs and increased exposure to multidisciplinary imaging discussions are essential to optimize urologists’ diagnostic proficiency and ultimately improve patient care.