Lack of Standardized PSMA PET/CT Reporting May Be Undermining Patient Care

A new analysis published in Radiology suggests that the absence of consistent, standardized reporting for PSMA PET/CT exams in the United States may be contributing to diagnostic errors, delayed care, and inconsistent follow-up for prostate cancer patients. The study, led by Dr. Herbert Alberto Vargas of NYU Langone Health, reviewed 111 PSMA PET/CT reports from 42 institutions and found widespread variability in how these scans are documented and interpreted.

Researchers observed significant differences in report length, structure, readability, and use of scoring systems. Only 11% of reports followed a standardized format, and fewer than half included longitudinal assessments for all detected lesions. While most reports included standardized uptake values (SUVs), details such as lesion size, extracapsular extension, and seminal vesicle invasion were often omitted. Information on lymph node or distant metastases was included in just 37% of reports, and even then, often lacked key anatomical details. Although incidental findings were mentioned in 89% of the cases, less than 20% of the reports offered guidance on how to manage those findings.

The study’s authors attribute these inconsistencies in part to the relative newness of PSMA PET reporting guidelines, first published in 2017, and to the confusion created by the existence of more than seven different scoring systems. A lack of training, access to educational resources, and clear direction on which system to use in specific clinical contexts may also be contributing to the problem.

To address these issues, the authors highlight the ongoing development of the Standardized PSMA PET Analysis and Reporting Consensus (SPARC), a collaborative effort involving multidisciplinary experts. SPARC aims to unify existing frameworks under one set of clear, consistent guidelines, with the goal of improving diagnostic accuracy, research consistency, and patient outcomes.

Until such standardized guidelines are finalized and widely adopted, the study urges institutions to prioritize multidisciplinary collaboration in order to implement validated scoring systems effectively. Without standardization, the risk remains that critical information will be lost or miscommunicated, potentially undermining the benefits of PSMA PET/CT in prostate cancer care.