How to cite: Rush BW. Novel Imaging in Urologic Oncology. Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/novel-imaging-in-urologic-oncology/
Summary
Benjamin W. Rush, MD, Clinical Assistant Professor of Hematology and Oncology and Assistant Professor of Cancer Medicine, Wake Forest University, Winston-Salem, North Carolina, reviews the clinical use of novel molecular imaging in urologic oncology, with a primary focus on prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging and the emerging application of Carbonic Anhydrase IX (CAIX)-based PET imaging in renal cell carcinoma.
Dr. Rush begins with an overview of PSMA biology and physiologic expression patterns. He reviews currently approved PSMA PET agents and discusses practical differences related to urinary excretion and tracer logistics that may influence scan interpretation and scheduling. He explains how PSMA PET is incorporated into initial staging for patients with unfavorable intermediate- or high-risk prostate cancer, citing data demonstrating improved diagnostic accuracy compared with conventional CT and bone scan imaging.
Dr. Rush highlights common pitfalls of PSMA PET interpretation including false positives related to benign lymphadenopathy, granulomatous disease, nerve ganglia, osteoblastic bone conditions, inflammatory bowel disease, and other malignancies. Dr. Rush places special emphasis on rib lesions, noting that isolated rib uptake should be interpreted cautiously.
Using data from the CONDOR trial, Dr. Rush examines PSMA PET imaging in biochemical recurrence, noting how the study’s results demonstrated high clinical localization rates and frequent changes in management. After outlining how prostate-specific antigen (PSA) thresholds influence scan sensitivity, Dr. Rush explains his approach to timing PSMA PET imaging following surgery or radiation.
Dr. Rush introduces CAIX-PET imaging for indeterminate renal masses, summarizes data demonstrating improved specificity for clear cell renal cell carcinoma, and discusses practical considerations, including scan timing and patient logistics.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today Conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
ABOUT THE AUTHOR
Benjamin W. Rush, MD, is a Clinical Assistant Professor of Hematology and Oncology and an Assistant Professor of Cancer Medicine at Wake Forest University in Winston-Salem, North Carolina. Dr. Rush has extensive experience in prostate cancer, renal neoplasms, and resection.
Dr. Rush earned his medical degree from the University of South Carolina in Columbia. He then completed a residency in Internal Medicine and a fellowship in Hematology/Oncology at Wake Forest University.
