Can FAPI-PET imaging address unmet needs in nephro-urology?

FAP-targeted PET radiotracers have shown considerable promise across multiple malignancies, offering improved tumour detection and characterisation compared with conventional imaging. Nephro-urological diseases pose particular diagnostic challenges, as both standard imaging and currently available PET tracers are limited by nonspecific uptake and high background signal related to renal excretion. Given the prominent role of tumour-associated fibroblasts in several nephro-urological cancers, FAP-targeted PET may help address key limitations of current staging and response assessment in this setting. Moreover, upregulated FAP expression is also observed in a range of benign nephro-urological conditions, underpinning growing interest in FAP-targeted PET beyond oncology. This review summarizes the biology of FAP expression in the nephro-urological tract and synthesizes emerging evidence on oncological and non-oncological applications of FAP-targeted PET, with a focus on refining lesion characterization, guiding personalised management, and identifying novel theranostic opportunities in nephro-urology. Taken together, current evidence suggests that FAP-targeted PET may become a valuable complement to existing imaging strategies in nephro-urology, although its standalone clinical utility remains uncertain and requires confirmation in larger, prospective, disease-specific studies before routine adoption.