Response Evaluation Criteria in PSMA-imaging (RECIP)

Novel evidence-based framework for response evaluation in metastatic prostate cancer using PSMA PET imaging.

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Developed by an international multi-disciplinary collaborative group of investigators
RECIP

Response Evaluation Criteria In PSMA-PET/CT (RECIP) is a standardized evidence-based framework developed by an interdisciplinary team of investigators to evaluate efficacy of systemic therapies in metastatic castration-resistant prostate cancer.

RECIP combines changes in total tumor volume and status of new lesions and can be calculated dual-way: Visual RECIP and Quantitative RECIP.

Visual RECIP: Changes in total volume are evaluated by visual reads of nuclear medicine physicians or radiologists, and are combined with status of new lesions to calculate RECIP.

Quantitative RECIP: Changes in total tumor volume are evaluated quantitatively using tumor segmentation software and combined with status of new lesions to calculate RECIP.

Visual RECIP and Quantitative RECIP showed 95% agreement for identifying progression vs. non-progression.

RECIP demonstrated excellent inter-reader agreement among 5 independent readers (complete agreement: 83% for visual RECIP and 92% for quantitative RECIP) which suggests that RECIP is ready for implementation in clinical practice.

RECIP 1.0 Definition

RECIP integrates changes in total PSMA-positive tumor volume (PSMA-VOL) between baseline and follow-up scan and occurrence of new lesions.

Complete Response
RECIP-CR
Absense of any PSMA-update on follow-up PET scan
Partial Response
RECIP-PR
≥30% decrease in PSMA-VOL without appearance of new lesions
Progressive Disease
RECIP-PD
≥20% increase in PSMA-VOL with appearance of new lesions
Stable Disease
RECIP-SD
<30% decrease in PSMA-VOL with/without appearance of new lesions or
≥30% decrease in PSMA-VOL with appearance of new lesions or
<20% increase in PSMA-VOL with/without appearance of new lesions or
≥20% increase in PSMA-VOL without appearance of new lesions
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PSMA-PET/CT Standardized Reporting

PROMISE V2 framework

PSMA-PET is emerging to become a reference imaging tool for the staging and restaging of patients with prostate cancer for both clinical routine and trials.

The prostate cancer molecular imaging standardized evaluation (PROMISE) criteria version 1 have been proposed as a comprehensive framework for whole-body staging to describe the prostate cancer disease extent on PSMA-PET.

PROMISE version 2 (V2) were recently published and provide harmonized TNM categories, improved assessment of local disease, and updated PSMA-expression score. A reporting template for response assessment in clinical trials by defining qualitative and quantitative imaging parameters to be recorded. The PROMISE V2 templates can serve as a basis for current and future response assessment frameworks.

aPROMISE

aPROMISE is an AI-based software that provides accurate quantitative imaging biomarkers of clinical value, increasing reproducibility in the assessment of disease.

aPROMISE have shown that AI-based automatic lesion detection and total tumor volume quantification using PSMA PET/CT imaging can be used to track treatment response and automatically calculate RECIP criteria (aRECIP) in patients with prostate cancer.

The AI-based automated algorithm aRECIP achieved the same clinical classifications as manual lesions selection and classification of RECIP in 100% of cases.

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Definition of original RECIP incorporated quantitative changes of PSMA-VOL calculated using semi-automatic software for whole-body tumor segmentation in PSMA PET. However, this process can still be time consuming with an average time of 10 minutes per scan. Hence, quantification of PSMA-VOL is not feasible yet for use in daily practice. Nevertheless, standardized treatment response evaluation in metastatic prostate cancer in clinical routine using next-generation PSMA imaging is an urgent need. In a recent study published in Radiology, RECIP investigators found that changes in PSMA-VOL determined visually by five board-certified nuclear medicine physicians had 95% correlation with quantitative changes in PSMA-VOL calculated using semi-automatic tumor segmentation software. These findings suggest that RECIP assessed by nuclear medicine physicians (Practical RECIP) can be used in daily practice.

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Our partners

Supported by our valued partners around the globe

The ProstateCancer Foundation (PCF) is the world's leading philanthropic organization dedicated to funding life-saving prostate cancer research. Development of RECIP has been funded by the PCF Young Investigator Award 21YOUN18.
PI: Andrei Gafita 

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