Prostate speciﬁc membrane antigen focal ablation imaging (PSMA-FAB) - Perspective Open

Sep 23, 2026

Uploaded by moss~

Prostate speciﬁc membrane antigen focal ablation imaging (PSMA-FAB) is presented as a dedicated imaging-based scoring approach to standardize evaluation after focal therapy for prostate cancer. The framework extends multiparametric MRI assessment using PI-FAB and incorporates PSMA PET/CT to guide follow-up decisions. PSMA-FAB 1 supports continued monitoring, PSMA-FAB 2 evaluates PSA kinetics and MRI with biopsy when suspicion arises, and PSMA-FAB 3 recommends biopsy, while FIRE-SCORE integrates both elements to improve patient management.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Perspective: PSMA-FAB imaging framework

Rationale for PSMA PET/CT integration

PSMA-FAB scoring categories

FIRE-SCORE for follow-up management

Focal therapy principles and clinical context

Role and standardization of mpMRI

MRI scoring systems (PI-FAB, TARGET)

Prostate Cancer and Prostatic Diseases [www.nature.com/pcan](www.nature.com/pcan) PERSPECTIVE OPEN Prostate speciﬁc membrane antigen focal ablation imaging (PSMA-FAB) Egesta Lopci 1 ✉, Massimo Lazzeri 2, Vittorio Fasulo2,3, Davide Maffei2,3, Pier Paolo Avolio2,3, Alessandro Tallari2,3, Stefano Moretto2,3, Ludovica Cella2,3, Marcello Rodari1, Federica Mrakic Sposta4, Paolo Casale 2, Nicolò Maria Bufﬁ2,3 and Giovanni Lughezzani2,3 © The Author(s) 2025, corrected publication 2025 | | The Prostate Imaging after Focal Ablation (PI-FAB) score has been recently proposed for scoring the appearance on multiparametric magnetic resonance imaging (mpMRI) of prostate cancer after focal therapy. The progressive implementation of prostate speciﬁc membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) into the management of prostate cancer has revolutionized the diagnostic work-up and inspired our proposal for a dedicated PSMA Focal Ablation Imaging (PSMA-FAB) scoring system. Based on pre-and post-treatment imaging, the classiﬁcation is categorized into: PSMA-FAB 1 (continue monitoring); PSMA-FAB2 (assess PSA kinetics and MRI, with biopsy to be considered in case of suspicion); and PSMA-FAB 3 (recommend biopsy) . Furthermore, a combined Focal-therapy Imaging Response Evaluation Score (FIRE-SCORE) embedding PI-FAB and PSMA-FAB scores | | | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | is suggested to help patient’s management at follow up. | | | | | Prostate Cancer and Prostatic Diseases (2026) 29:529–534; [https://doi.org/10.1038/s41391-025-01005-3](https://doi.org/10.1038/s41391-025-01005-3) | | | | | | Focal therapy represents a targeted, minimally invasive treatment option for prostate cancer that concentrates on eliminating cancerous tissue within the prostate while sparing the rest of the gland. This approach is particularly appropriate for patients with localized tumors conﬁned to speciﬁc areas, which are typically identiﬁed using advanced imaging and biopsy techniques [1]. Several energy-based technologies can be employed in focal therapy to ablate cancer cells. These include high-intensity focused ultrasound (HIFU), cryotherapy, radiofrequency ablation (RFA), photodynamic therapy (PDT), and irreversible electroporation (IRE) [2]. By means of these energy sources, focal therapy aims to eliminate cancerous cells while preserving the surrounding healthy tissue and by minimizing the side effects and functional disorders [3]. Early clinical studies, have shown in fact encouraging results in terms of preserving urinary continence and sexual function. However, patients undergoing focal therapy require close follow-up and comprehensive counseling regarding the potential beneﬁts and uncertainties of this approach. At present, the European Association of Urology (EAU) guidelines consider focal therapy with HIFU or cryotherapy in low-intermediate risk prostate cancer patients, as an alternative to active surveillance or radical therapy, in the context of clinical trials or prospective registries [1]. This recommendation derives from the observation that focal therapy results can be particularly beneﬁcial when performed in Centers of excellence, able of concentrating large cohorts of patients with over 5–15 years of follow-up and long-term monitoring of oncological and functional outcomes [3–6]. Multiparametric magnetic resonance imaging (mpMRI) has emerged as a vital imaging technique in both diagnosing and managing prostate cancer, especially when considering focal therapy [7] . This approach integrates multiple imaging sequences—such as T2-weighted, diffusion-weighted, and dynamic contrastenhanced imaging—to accurately identify and localize clinically signiﬁcant tumors within the prostate gland [8–11] . Beyond its pre-treatment application, mpMRI plays a key role in monitoring patients after focal therapy. Unlike whole-gland treatments where p

FAQs

What problem does PSMA-FAB scoring address in prostate cancer follow-up?

PSMA-FAB targets the difficulty of interpreting post-focal therapy imaging, where tissue changes can obscure residual or recurrent disease, and where PSA is less reliable after treatment.

How are the PSMA-FAB categories used during follow-up?

PSMA-FAB 1 supports continued monitoring; PSMA-FAB 2 assesses PSA kinetics and MRI and considers biopsy if suspicion exists; PSMA-FAB 3 recommends biopsy.

What is FIRE-SCORE and how does it relate to PI-FAB and PSMA-FAB?

FIRE-SCORE is suggested as a combined response evaluation score that embeds PI-FAB and PSMA-FAB to help structure management decisions at follow-up.

Sep 23, 2026

Uploaded by moss~