Mantica Guglielmo, Chierigo Francesco, Ambrosini Francesca, D'Amico Francesca, Celesti Greta, Ferrari Arianna, Gallo Fabrizio, Schenone Maurizio, Benelli Andrea, Introini Carlo, Leonardi Rosario, Calarco Alessandro, Esperto Francesco, Pacchetti Andrea, Papalia Rocco, Bozzini Giorgio, Serao Armando, Pau Valentina, Sambuceti Gianmario, Terrone Carlo, Fornarini Giuseppe, Bauckneht Matteo
Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16126 Genova, Italy.
IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy.
Cancers (Basel). 2025 Jun 24;17(13):2122. doi: 10.3390/cancers17132122.
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.
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.
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.
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.
前列腺特异性膜抗原（PSMA）-PET成像显著改善了前列腺癌（PCa）的分期，但其解读仍然具有挑战性，即使对于经验丰富的专家也是如此。此前尚无研究评估泌尿外科医生解读PSMA-PET的能力。
我们开展了一项多中心前瞻性研究，纳入了来自意大利8家机构的63名泌尿外科医生。参与者对20例高危PCa病例的PSMA-PET扫描进行评估，未提供临床信息。熟练程度定义为在≥75%的病例中正确识别三个分期组成部分（T、N、M）中的至少两个。使用单变量和多变量逻辑回归分析了表现与层级（住院医生与顾问医生）、机构类型、手术量和多学科团队（MDT）存在等因素之间的关联。
只有一名参与者达到了完全分期熟练程度，而44%的参与者达到了部分（几乎正确）分期的≥75%阈值。每年PCa诊断数≥300例的中心的泌尿外科医生在T和M分期识别方面表现更好。每年机器人辅助根治性前列腺切除术（RARP）≥150例的机构以及有MDT的机构在M分期方面显示出更高的准确性。多变量分析中未出现熟练程度的显著预测因素，尽管层级和手术量在淋巴结转移检测方面接近显著水平。
泌尿外科医生对PSMA-PET的解读很复杂，在T和M分期方面尤其具有挑战性。高机构病例量和MDT参与可能会提高解读技能。结构化培训计划以及增加多学科影像讨论的接触对于优化泌尿外科医生的诊断熟练程度并最终改善患者护理至关重要。
