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.
背景：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，但其解读仍具挑战性，即使对于经验丰富的专家亦是如此。此前尚无研究评估泌尿科医生解读PSMA-PET的能力。方法：我们开展了一项多中心前瞻性研究，纳入了来自八家意大利机构的63名泌尿科医生。参与者评估了20例高危前列腺癌患者的PSMA-PET扫描图像，未提供临床信息。熟练度定义为在≥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。采用单变量和多变量逻辑回归分析表现与职称（住院医师与顾问医师）、机构类型、手术量以及多学科团队（MDT）参与等因素之间的关联。结果：仅一名参与者达到完全分期熟练度，而44%的参与者达到了部分（接近正确）分期的≥75%阈值。来自每年诊断≥300例前列腺癌的中心泌尿科医生在T和M分期识别方面表现更佳。每年实施≥150例机器人辅助根治性前列腺切除术（RARP）的机构以及设有MDT的机构在M分期方面准确率更高。多变量分析中未出现显著的熟练度预测因素，尽管职称和手术量在淋巴结转移检测方面接近显著性。结论：PSMA-PET解读对泌尿科医生而言较为复杂，尤其在T和M分期方面存在挑战。较高的机构病例量和MDT参与可能提升解读技能。结构化的培训计划以及增加参与多学科影像讨论的机会，对于优化泌尿科医生的诊断能力并最终改善患者护理至关重要。
Interpretation of PSMA-PET Among Urologists: A Prospective Multicentric Evaluation
肿瘤(癌症)患者之家