# PSMA-RADS (PSMA reporting and data system)

Source: https://nuclide.cc/terms/psma-rads/  
Nuclide record `psma-rads` (Term). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

A standard 1-to-5 scale that nuclear medicine doctors use to describe how likely a spot seen on a PSMA PET scan is to be prostate cancer, so different hospitals describe the same finding the same way.

## Summary

PSMA-RADS version 1.0, proposed by Rowe, Pienta, Pomper and Gorin at Johns Hopkins in 2017-2018, is a structured reporting system for PSMA-targeted PET imaging modelled on other "reporting and data systems" such as BI-RADS. It assigns each lesion a category from 1 (benign, subdivided into 1A without uptake and 1B with uptake but known-benign) through 2 (likely benign, low-level uptake atypical for prostate cancer), 3A/3B/3C/3D (equivocal, warranting further work-up such as biopsy or 3-6 month follow-up imaging), 4 (intense uptake typical of prostate cancer but without a corresponding finding on conventional imaging) to 5 (intense uptake with a corresponding conventional-imaging finding, prostate cancer almost certainly present). Reports give up to five target lesions a PSMA-RADS category plus an overall scan score equal to the highest individual lesion score.

Interobserver agreement studies on 18F-DCFPyL PET/CT found good-to-excellent agreement (intraclass correlation coefficients of 0.60-0.84 depending on lesion type), supporting its reproducibility across readers. A revised PSMA-RADS 2.0 has since been proposed, folding the 1A/1B split into a single benign category, allowing PSMA-RADS 3A/3B/3D lesions to be reclassified as 4 in patients with widespread metastatic disease, and adding a 5T subcategory for effectively treated metastases after systemic prostate cancer therapy.

The system is complementary to PSMA PET-guided treatment decisions (for example selecting patients for lutetium-177 or actinium-225 PSMA radioligand therapy) but is not itself a treatment-eligibility threshold; eligibility criteria used in trials such as VISION relied on separate PSMA-positivity rules.

## Fields

- Kind: Term
- Last checked: 2026-09-22
- Tags: reporting system; PSMA PET; structured reporting

## Sources

- Rowe SP, Pienta KJ, Pomper MG, Gorin MA. Proposal for a Structured Reporting System for PSMA-Targeted PET Imaging: PSMA-RADS Version 1.0. J Nucl Med 2018;59:479-485: https://jnm.snmjournals.org/content/jnumed/59/3/479.full.pdf
- Werner RA, et al. Interobserver Agreement for PSMA-RADS 1.0 on 18F-DCFPyL PET/CT. J Nucl Med (2018): https://jnm.snmjournals.org/content/jnumed/early/2018/09/06/jnumed.118.217588.full.pdf
- PSMA-RADS: updated version 2.0 discussion (PMC, 2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC11981304/

## Connected records

- technologies: [PSMA PET](https://nuclide.cc/technologies/psma-pet/)
- targets: [PSMA](https://nuclide.cc/targets/psma/)
- drugs: [Gallium-68 gozetotide (PSMA-11)](https://nuclide.cc/drugs/ga68-psma-11/), [Lutetium-177 vipivotide tetraxetan](https://nuclide.cc/drugs/pluvicto/), [Piflufolastat F-18 / Pylarify TruVu](https://nuclide.cc/drugs/pylarify/)
- indications: [Metastatic castration-resistant prostate cancer](https://nuclide.cc/indications/prostate-mcrpc/)
- trials: [VISION](https://nuclide.cc/trials/vision/)
- isotopes: [Actinium-225](https://nuclide.cc/isotopes/ac-225/), [Fluorine-18](https://nuclide.cc/isotopes/f-18/), [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)
- terms: [Tumour-to-background ratio (TBR)](https://nuclide.cc/terms/tumour-to-background-ratio/)

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