How to cite: Sidana A. “Panel Discussion: MRI and PSMA Discordance.” October, 2025. Accessed Apr 2026. https://grandroundsinurology.com/panel-discussion-mri-and-psma-discordance/
Summary
A multidisciplinary group of imaging experts led by Abhinav Sidana, MD, MPH, FACS, Associate Professor, Surgery, Director, Prostate Cancer Focal Therapy Program, Director, GU Clinical Trials, Co-Director, High-Risk and Advanced Prostate Cancer Clinic, Urologic Oncologist, University of Chicago, Chicago, Illinois, discusses clinical cases to explore magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography (PSMA PET) discordance. In the first case, a seventy-two-year-old man presents with elevated prostate-specific antigen (PSA) and a strong family history of prostate cancer. Multiparametric MRI shows two left peripheral zone lesions, scored Prostate Imaging Reporting and Data System (PI-RADS) 4 and PI-RADS 3. Targeted and systematic biopsies confirm the presence of Grade Group 2 and Grade Group 3 disease across multiple left-sided cores. PSMA PET demonstrates focal uptake with standardized uptake values (SUVs) of 9.5 and 12.2 in the same region. The panel examines how MRI and PSMA PET complement each other and how PSMA uptake influences lesion confidence, especially when MRI lesions vary in conspicuity or location.
Another case involves a sixty-year-old man with recurrent localized disease after focal therapy. He has prior right-sided Grade Group 2 cancer and desires further focal treatment. Pre-treatment MRI shows a dominant lesion. Follow-up MRI at six to twelve months demonstrates an expected post-ablation defect. At twenty-four months, new suspicious changes appear in the left posterior peripheral zone. PSMA PET reveals focal uptake corresponding to the latest MRI abnormality. The panel discusses how temporal imaging changes after ablation complicate MRI interpretation, how PSMA PET can clarify suspected recurrence, and how discordance affects retreatment planning.
The panel emphasizes that discordance does not represent failure of either modality. It reflects differing sensitivity profiles, temporal changes after therapy, and the biologic heterogeneity of prostate cancer. The experts highlight how combining MRI and PSMA PET enhances lesion characterization, reduces uncertainty in focal therapy decisions, and improves patient-specific management strategies.
Frontiers in Oncologic Prostate Care and Ablative Local Therapy (FOCAL) is an outstanding program on prostate imaging, transperineal interventions, and ablative treatments for prostate cancer and benign prostatic hyperplasia. Bringing together community-based, academic, and industry partners, FOCAL offers lectures by world-renowned faculty and hands-on training workshops on in-office transperineal interventions, fusion-guided prostate ablation and state-of-the-art BPH management with novel technologies.
ABOUT THE AUTHOR
Abhinav Sidana, MD, MPH, FACS, is an Associate Professor of Surgery, the Director of the Prostate Cancer Focal Therapy Program, the Co-Director of the High-Risk and Advanced Prostate Cancer Clinic, and a Urologic Oncologist at the University of Chicago in Illinois. Dr. Sidana specializes in prostate and kidney cancer, performing both robotic and open surgery for patients diagnosed with urologic cancers. He offers robotic prostatectomy for patients with more aggressive prostate cancer, and performs open and robotic surgery for patients with complex, multifocal, and advanced kidney cancers. Dr. Sidana’s research focuses on providing organ-preserving treatment, with lower side effects, for prostate cancer. He has extensive experience with cryoablation, high-intensity focused ultrasound ablation, TULSA Pro, and irreversible electroporation of the prostate.
Steven P. Rowe, MD, PhD, is an Professor of Radiology at University of Texas Southwestern Medical Center, Dallas, Texas. He clinically practices both diagnostic radiology and nuclear medicine, and his research work focuses on applications of novel molecular imaging agents for positron emission tomography (PET) and single-photon emission computed tomography (SPECT). He is particularly interested in the use of prostate-specific membrane antigen (PSMA)-targeted PET agents in prostate cancer and renal cell carcinoma, as well as the clinical utilization of 99mTc-sestamibi SPECT for non-invasive characterization of renal masses. He and his colleagues recently developed and validated a structured reporting system for delineating and codifying findings on PSMA PET known as PSMA Reporting and Data System (PSMA-RADS).
Mark Emberton, MD, FRCS, is Dean for the Faculty of Medical Sciences, and Professor of Interventional Oncology for the Division of Surgery and Interventional Science at University College London in London, England. He is also an Honorary Clinical Director of the Clinical Effectiveness Unit at the Royal College of Surgeons of England, and UCL Partners' Pathway Director for urological oncology for London Cancer. Professor Emberton’s clinical research is aimed at improving the diagnostic and risk stratification tools and treatment strategies for prostate cancer. He specializes in the implementation of new imaging techniques, nanotechnologies, bio-engineering materials, and non-invasive treatment approaches, such as high intensity focused ultrasound and photo-dynamic therapy.
Arvin K. George, MD, serves as Director of Prostate Cancer Programs and Associate Professor (PAR) of Urology at Johns Hopkins School of Medicine in Baltimore, Maryland. He is a urologic surgeon who specializes in the diagnosis and management of genitourinary cancers. After obtaining his medical degree from the Royal College of Surgeons in Ireland, he completed his urology residency at the Smith Institute for Urology at the Hofstra North Shore-LIJ School of Medicine. He remained there to complete his endourology fellowship in New York, gaining additional subspecialty expertise in robotic, laparoscopic, and percutaneous surgery. Subsequently, he completed a urologic oncology fellowship at the National Cancer Institute of the National Institutes of Health. Dr. George’s research interests include minimally-invasive and image-guided treatments, functional prostate imaging, and focal therapy for prostate cancer. His research aims to identify appropriate use for imaging in diagnosis, risk stratification, and management of prostate cancer, including active surveillance and selection/treatment of patients with novel focal therapy modalities.
Sadhna Verma, MD, MBA, FSAR, is an Adjunct Professor-Affiliate of Radiology at the University of Cincinnati in Ohio. Dr. Verma established and continues to serve as the Director of the Prostate MRI Program at the University of Cincinnati and established the university’s CT imaging program for CT Urography and CT Enterography. Dr. Verma is the associate Chair of Quality and Performance Improvement at the Prostate Cancer Midwest Center of Excellence and the Director of the Prostate Cancer Imaging Program for the U.S. Department of Veterans Affairs. She is an international expert in the fields of GI and GU Imaging.
Dr. Verma earned her medical degree from the University of Louisville in Kentucky. She then completed an internship in Internal Medicine at the University of Pittsburgh in Pennsylvania. Dr. Verma completed a residency in Diagnostic Radiology and a fellowship in Health Service and Outcomes Research at the University of Cincinnati and then completed a fellowship in Body Imaging/3D Imaging at Johns Hopkins University in Baltimore, Maryland. Dr. Verma earned her MBA from the University of Chicago Booth School of Business in Illinois.
Dr. Verma is a member of the International Prostate MRI Working Group. She conducts local and national workshops to help train radiologists and inform clinicians and patients about this test. Dr. Verma has over 100 published articles and book chapters in her field.
