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Purpose: The aim of this study was to determine the agreement between three observers with different levels of experience using the PSMA-RADS 2.0 criteria and the miTNM system for the interpretation of PET-PSMA with [ 18 F]DCFPyL in males with prostate cancer., Materials and Methods: PET-PSMA images from 114 prostate cancer patients were blindly reported twice by three different observers at intervals of 8 weeks. The evaluations were performed according to the molecular imaging TNM (miTNM) and PSMA-RADS 2.0 criteria. We used Fleiss' Kappa to analyse inter and intraobserver agreements., Results: Moderate overall agreement was obtained in the assessment of the PET-PSMA results (Fleiss'k = 0.53; 95% CI 0.45-0.62; p < 0.001), with significant agreement in the miT, miN and miM reports. There was a substantial level of agreement in the reporting of prostatic disease and lymphatic involvement (Fleiss'k = 0.66 and 0.65), being lower than that observed in the reporting of metastatic disease (Fleiss'k = 0.86), especially in the M0 group (Fleiss'k = 0.99). Upon re-evaluation of the images, observer 1 had moderate overall agreement for miT (Fleiss'k = 0.51) and substantial agreement for miN and miM (Fleiss'k 0.75 and 0.63, respectively)., Conclusions: The use of a structured scoring system such as PSMA-RADS 2.0, as well as the miTNM classification system in the interpretation of PET-PSMA images in prostate cancer patients, provides a highly reproducible report format. High levels of interobserver and intraobserver agreement are found, especially when ruling out disease, which supports its use in routine clinical practice., (Copyright © 2024 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Radium-223 is an alpha-emitting radiopharmaceutical that significantly prolongs overall survival in patients with castration-resistant prostate cancer and symptomatic bone metastases. We report a retrospective analysis of our clinical experience with Radium-223 in the first 68 patients treated., Methods: The incidence of hematologic, gastrointestinal, and other adverse events was identified, including events that led to treatment discontinuation or delay. Alterations in bone pain and prostate-specific antigen and serum alkaline phosphatase levels were evaluated. Bone scan changes were identified and correlated with the clinical course., Results: Sixty-eight patients were included in the study. The median number of radium-223 injections was 5 (range 1-6), with 69% of patients receiving 5 to 6 injections. The most common side effects were digestive alterations in 24 patients, anemia in 7 patients, and thrombocytopenia in 5 patients. Clear downward trends in serum alkaline phosphatase were seen, that were less clear in prostate-specific antigen. Mean serum alkaline phosphatase decreased from baseline in 77% of the patients, and prostate-specific antigen in less than 40%. The majority of patients (62) experienced an improvement in bone pain intensity or no increase in bone pain intensity. No prostate-specific antigen flare phenomenon was noted., Conclusions: Radium-223 was generally well tolerated and there were no safety concerns. The adverse events were mild and manageable. A decline in serum alkaline phosphatase was more common than a decline in prostate-specific antigen. Monitoring changes in serum alkaline phosphatase dynamics may be useful., (Copyright © 2019 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)