Akademik Veri Yönetim Sistemi
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, cilt.53, sa.5, ss.2955-2962, 2026 (SCI-Expanded, Scopus)
Active surveillance (AS) is a central management strategy for men with low-risk prostate cancer, aiming to avoid over-treatment while preserving the opportunity for curative intervention if progression occurs. A key challenge, however, is the accurate identification of clinically significant prostate cancer (csPCa) at baseline. Despite the integration of multiparametric MRI (mpMRI) and targeted biopsy into routine practice, biopsy-derived ISUP Grade Group 1 frequently underestimates true tumor grade, contributing to diagnostic uncertainty within AS pathways. Prostate-specific membrane antigen (PSMA) PET/CT has emerged as a potential complementary tool, supported by evidence linking PSMA expression with tumor aggressiveness. Ongoing prospective studies-PRIMARY2, CONFIRM and BiPASS-are evaluating whether PSMA PET can refine detection of csPCa, reduce false-negative biopsies and inform patient selection. However, existing PET-based assessment approaches were not specifically designed for AS, and their performance in post-biopsy, low-risk populations remain to be established. The Istanbul PSMA PET/CT Criteria (IPPC) were developed to provide a structured, reproducible method for categorizing intraprostatic PSMA uptake in men with ISUP Grade Group 1-2 disease being considered for AS. IPPC integrates morphological features, uptake intensity and delayed pelvic imaging to support risk stratification after biopsy. The ongoing I-SELECT study is designed to explore whether this framework can improve csPCa detection and guide AS decision-making in clinical practice.