Comparative analysis of PSMA-RADS Version 2.0 versus bone uptake metastatic probability (BUMP) score for characterising focal bone uptake on [18F]PSMA-1007 PET/CT in prostate cancer – a multicentre evaluation
5 affiliations
- 1Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- 2Faculty of Medicine and Health, University of Leeds, Leeds, UK
- 3University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- 4Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- 5Mirada Medical Ltd, Oxford, UK
Abstract
Purpose: Prostate-specific membrane antigen (PSMA) PET/CT is widely used in prostate cancer management, but unspecific bone uptake (UBU) remains a diagnostic challenge particularly with [18F]PSMA-1007. Bone uptake metastatic probability (BUMP) score - a composite imaging-clinical model, was compared with PSMA Reporting and Data System (PSMA-RADS, Version 2) for predicting skeletal metastases in UBU.
Methods: A real-world cohort of [18F]PSMA-1007 PET/CT scans performed at three tertiary cancer centres was retrospectively analysed. Bone lesions with focal PSMA uptake were evaluated. SUVmax, CT-derived mean Hounsfield unit and androgen deprivation therapy status were recorded to calculate BUMP score for each lesion. Lesional PSMA-RADS scores were assigned by experienced radiologists. Ground truth was established using follow-up imaging, prostate-specific antigen (PSA) kinetics and multidisciplinary consensus. Receiver operating characteristic (ROC) analyses assessed diagnostic performance.
Results: 130 patients (median age 70 years) with 412 bone lesions were analysed; 60.9% (n = 251) of lesions were metastatic. Median SUVmax was higher in malignant than benign lesions: 7.54 (Interquartile range (IQR) 10.3) versus 3.53 (IQR 1.51). BUMP achieved an AUROC of 0.812 (95% CI: 0.636—0.931), the optimal threshold was 0.134 yielding an F1 score of 0.800. PSMA-RADS v2.0 outperformed BUMP with higher sensitivity and specificity (98% and 96%, versus 74% and 80%). In equivocal PSMA-RADS Score 3 lesions (n = 44), BUMP showed reduced discrimination (AUROC 0.61, 95% CI 0.457–0.781).
Conclusion: BUMP had good predictive ability for classifying bone metastases but underperformed compared with human-led PSMA-RADS assessment. For equivocal lesions BUMP offered limited added value, highlighting the importance of expert interpretation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08154-0.
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BibTeX
@article{cairns2026comparative,
title = {{Comparative analysis of PSMA-RADS Version 2.0 versus bone uptake metastatic probability (BUMP) score for characterising focal bone uptake on [18F]PSMA-1007 PET/CT in prostate cancer – a multicentre evaluation}},
author = {James Cairns and Salman Arain and Amarnath Challapalli and Amalia Stavropoulos and Tamir Ali and Daniel Ward and John Sage and Georgia Ionescu and Julien M. Y. Willaime and Russell Frood and Amit Bahl and George Petrides and Andrew Scarsbrook},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = sep,
doi = {10.1007/s00259-026-08154-0},
url = {https://doi.org/10.1007/s00259-026-08154-0},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative analysis of PSMA-RADS Version 2.0 versus bone uptake metastatic probability (BUMP) score for characterising focal bone uptake on [18F]PSMA-1007 PET/CT in prostate cancer – a multicentre evaluation
AU - James Cairns
AU - Salman Arain
AU - Amarnath Challapalli
AU - Amalia Stavropoulos
AU - Tamir Ali
AU - Daniel Ward
AU - John Sage
AU - Georgia Ionescu
AU - Julien M. Y. Willaime
AU - Russell Frood
AU - Amit Bahl
AU - George Petrides
AU - Andrew Scarsbrook
PY - 2026
DA - 2026/09/01
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08154-0
UR - https://doi.org/10.1007/s00259-026-08154-0
AB - Purpose: Prostate-specific membrane antigen (PSMA) PET/CT is widely used in prostate cancer management, but unspecific bone uptake (UBU) remains a diagnostic challenge particularly with [18F]PSMA-1007. Bone uptake metastatic probability (BUMP) score - a composite imaging-clinical model, was compared with PSMA Reporting and Data System (PSMA-RADS, Version 2) for predicting skeletal metastases in UBU. Methods: A real-world cohort of [18F]PSMA-1007 PET/CT scans performed at three tertiary cancer centres was retrospectively analysed. Bone lesions with focal PSMA uptake were evaluated. SUVmax, CT-derived mean Hounsfield unit and androgen deprivation therapy status were recorded to calculate BUMP score for each lesion. Lesional PSMA-RADS scores were assigned by experienced radiologists. Ground truth was established using follow-up imaging, prostate-specific antigen (PSA) kinetics and multidisciplinary consensus. Receiver operating characteristic (ROC) analyses assessed diagnostic performance. Results: 130 patients (median age 70 years) with 412 bone lesions were analysed; 60.9% (n = 251) of lesions were metastatic. Median SUVmax was higher in malignant than benign lesions: 7.54 (Interquartile range (IQR) 10.3) versus 3.53 (IQR 1.51). BUMP achieved an AUROC of 0.812 (95% CI: 0.636—0.931), the optimal threshold was 0.134 yielding an F1 score of 0.800. PSMA-RADS v2.0 outperformed BUMP with higher sensitivity and specificity (98% and 96%, versus 74% and 80%). In equivocal PSMA-RADS Score 3 lesions (n = 44), BUMP showed reduced discrimination (AUROC 0.61, 95% CI 0.457–0.781). Conclusion: BUMP had good predictive ability for classifying bone metastases but underperformed compared with human-led PSMA-RADS assessment. For equivocal lesions BUMP offered limited added value, highlighting the importance of expert interpretation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08154-0.
SN - 1619-7070
SN - 1619-7089
ER -