How to cite: Tagawa ST. “Novel Indications for Molecular Targeted Imaging (Focus on PSMA PET).” Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/novel-indications-for-molecular-targeted-imaging-focus-on-psma-pet/
Summary
Scott T. Tagawa, MD, MS, FASCO, FACP, Professor of Medicine & Urology, Weill Cornell Medicine, New York, New York, examines expanding and emerging indications for molecular targeted imaging in prostate cancer, with emphasis on prostate-specific membrane antigen positron emission tomography (PSMA PET) for patient selection, prognostication, and response assessment.
Molecular targeted imaging relies on selective cell-surface targeting, most commonly PSMA in prostate cancer. While biochemical recurrence and initial staging of intermediate- and high-risk disease are considered established indications, additional roles are evolving.
PSMA expression is common but not universal. Inter- and intrapatient heterogeneity has been demonstrated, including lower average expression in certain metastatic sites such as the liver and in select histologic subtypes. This variability has implications for imaging-based therapeutic selection.
In metastatic castration-resistant disease treated with lutetium-177–PSMA-617, a higher baseline standardized uptake value mean is associated with improved radiographic progression-free and overall survival. Artificial intelligence-assisted quantification reduces the labor required for whole-body standardized uptake value assessment. Visual read criteria, as used in VISION, differ from real-world reporting practices, and most clinicians rely on overall impression rather than strict trial criteria.
Emerging applications include response assessment using PET- and SPECT-based Response Evaluation Criteria in PSMA Imaging, which correlate with survival in retrospective analyses. Prostate Cancer Working Group 4 guidance incorporates PSMA PET into progression criteria for clinical trials, including thresholds for confirming new lesions.
Dr. Tagawa shares future directions, including quantitative assessment, repeat imaging after PSMA-targeted and non–PSMA-targeted therapies, and integration of imaging biomarkers to guide treatment duration and sequencing.
The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 36 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts.
ABOUT THE AUTHOR
Scott T. Tagawa, MD, MS, FACP, FASCO, is a Professor of Medicine and Urology, Director of Genitourinary Oncology for the Division of Hematology and Oncology, and Director of Medical Oncology of the Deane Prostate Health and Research Center at Weill Cornell in New York, New York. Dr. Tagawa leads clinical trials in the areas of prostate, kidney, and bladder cancer, as well as the prevention and treatment of thrombosis with cancer. He specializes in drug development and theranostics in prostate cancer. Dr. Tagawa earned his medical degree from the University of Southern California in Los Angeles, where he subsequently completed an internship and residency in Internal Medicine, serving as Chief Resident. Dr. Tagawa then completed fellowships in Hematology and Oncology, serving as Chief Fellow for each, also at the University of Southern California. He then earned his MS degree in Clinical Investigation at Weill Cornell in New York City. Dr. Tagawa also serves as leader of the GU Disease Management Team and co-leader of the Experimental Therapeutics Program of the Meyer Cancer Center. He is the WCM principal investigator for the Alliance for Clinical Trials in Oncology (formerly CALGB), serving on the Board of Directors and as a funded member of the Genitourinary Committee. Additionally, he serves on the editorial boards of many journals, is a member of numerous national and international medical and scientific societies, and has been named on multiple “top doctor” award lists, including Castle-Connolly, America’s Top Doctors for Cancer, and Top Doctors: New York Metro Area.
