Advances and challenges of PET imaging in bladder cancer-An update and future trends.

Molecular imaging with positron emission tomography (PET) is a powerful tool in the clinical management of bladder cancer, providing functional information that complements conventional anatomical imaging. This review summarizes the current role of PET imaging for bladder cancer care, highlighting the strengths and limitations of FDG, and explores future directions, including emerging non-FDG tracers that target alternative aspects of tumor biology, such as specific receptors, fibroblast activation or Nectin-4 expression, which may improve lesion detectability and better characterize disease leading to more precise treatments. In parallel, we discuss key technological advances, including PET/MRI, integration of quantitative PET with radiomics, and artificial intelligence-driven analysis, all of which hold promises for enhancing diagnostic accuracy, refining risk stratification, and supporting personalized clinical decision-making in bladder cancer management.