An assessment of conformance to structured reporting framework in 68Ga prostate-specific membrane antigen PET/computed tomography for prostate cancer staging.

Background: 68Ga prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) plays a critical role in prostate cancer management. Most clinical reports, however, remain unstructured, increasing the risk of omitting essential diagnostic information. Although standardized frameworks such as PROMISE (Prostate Cancer Molecular Imaging Standardized Evaluation) have been proposed to improve consistency, real-world adherence remains variable. This study assessed the adequacy of 68Ga PSMA PET/CT reports and evaluated their alignment with PROMISE recommendations.

Methods: A total of 189 68Ga PSMA PET/CT reports were retrospectively reviewed and scored based on the presence (1) or absence (0) of six diagnostic elements: primary tumor localization, PSMA uptake intensity, lymph node involvement, bone metastases, visceral metastases, and seminal vesicle involvement. Reports were classified as clinically adequate (score ≥5), partially adequate (3-4), or inadequate (<3). A one-sample z test assessed whether the proportion of adequate reports met a 90% benchmark (α = 0.05). Chi-square tests evaluated differences in reporting frequencies across elements.

Results: None of the reports (0%) were inadequate. Of 189 reports, 95 (50.3%) were clinically adequate (score ≥5) and 94 (49.7%) were partially adequate (score 3-<5), with a significant overall adequacy rate (P < 0.0001). A notable gap existed between documentation of seminal vesicle involvement and prostate size (P < 0.0001). Despite consistent reporting of anatomical localization and molecular imaging tumour, node, metastases (miTNM) classification, key elements were often missing, including PSMA uptake metrics, lesion size, nodal features, CT parameters, imaging protocol, and reader confidence.

Conclusion: In this single-center study, free-text 68Ga PSMA PET/CT reports were adequate for clinical needs but demonstrated only partial conformity to the PROMISE framework.