We established prognostic nomograms incorporating prostate-specific membrane antigen (PSMA) positron emission tomography (PET) parameters standardised by Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE; PPP1).
Here, we develop an updated PPP2 risk score from a large international multicentre registry study.
We included 6128 prostate cancer patients who underwent PSMA-PET at 20 hospitals in Europe, USA, and Australia between 2013 and 2022. Investigator sites were split 2:1 into the development (4044 patients) and validation (2084 patients) cohorts. We created nomograms of version 2 (PPP2) based on Cox regression models with the least absolute shrinkage and selection operator penalty for overall survival (development cohort). Performance of both nomograms was measured using Harrell's C-index and calibration plots and a head-to-head comparison with the National Comprehensive Cancer Network (NCCN) risk score by receiver operating characteristic curves (validation cohort).
Predictors were distant metastases (extrapelvic nodal metastases [M1a], bone metastases [M1b], and visceral metastases [M1c]), PSMA expression score, and total lesion count (visual PPP2) or total tumour volume (quantitative PPP2). C-indices (95% confidence interval) in the validation cohort were 0.80 (0.78-0.82; visual) and 0.80 (0.79-0.82; quantitative), respectively. Accuracy of both the PPP2 nomograms was superior to the NCCN risk score (n = 1034, area under the curve 0.84 vs 0.76; p < 0.001). The retrospective design represents a limitation of the study.
PPP nomograms were improved in an international multicentre study to predict accurately the 3- and 5-yr overall survival probabilities of prostate cancer. PPP2 yielded superior accuracy to the NCCN risk score. A free software tool has been created for PROMISE and PPP2 assessments (promise-pet.org).
European urology. 2025 May 02 [Epub ahead of print]
Madeleine J Karpinski, Kambiz Rahbar, Martin Bögemann, Laya Rahbar Nikoukar, Michael Schäfers, Sebastian Hoberück, Matthias Miederer, Tobias Hölscher, Sazan Rasul, Marcin Miszczyk, Francesco Lanfranchi, Matteo Bauckneht, Christian H Pfob, Felix Kind, Karolien Goffin, Anika Hüsing, Claudia Kesch, Ken Herrmann, Martin Stuschke, Andrei Gafita, Johannes Hüsing, Jeremie Calais, Michael S Hofman, Thomas A Hope, Jonathan Miksch, Timo F W Soeterik, Andrea Di Giorgio, Andrea Farolfi, Anders Bjartell, Elin Trägårdh, Lena M Unterrainer, Adrien Holzgreve, Gabriel T Sheikh, Isabel Rauscher, Matthias Eiber, Boris A Hadaschik, Wolfgang P Fendler
Department of Nuclear Medicine, DKTK and NCT University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany. Electronic address: ., Department of Nuclear Medicine, University Hospital Münster, Münster, Germany., Department of Urology, University Hospital Münster, Münster, Germany., Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany., Department of Translational Imaging in Oncology, National Center for Tumour Diseases (NCT/UCC) Dresden: Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany., Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University Vienna, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland., Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy., Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy., Nuclear Medicine, University of Augsburg, Augsburg, Germany., Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Nuclear medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium., Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany., Department of Urology, University Hospital Essen, Essen, Germany., Department of Nuclear Medicine, DKTK and NCT University Hospital Essen, Essen, Germany., Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany., The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Cancer Registry North-Rhine Westphalia, Bochum, Germany., Ahmanson Translational Theranostics Division, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Sir Peter MacCallum Department of Oncology and Department of Medicine, University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia., Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA., Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany; Department of Radiology, University Hospital Ulm, Ulm, Germany., Department of Urology, St Antonius Ziekenhuis, Nieuwegein/Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands., Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy., Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy., Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden., Department of Translational Medicine, Lund University, Malmö, Sweden; Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden., Ahmanson Translational Theranostics Division, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany; Bavaria Cancer Research Centre (BZKF), Partner Site Munich, Munich, Germany., Ahmanson Translational Theranostics Division, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany., Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany., Department of Nuclear Medicine, School of Medicine and Health, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany., Bavaria Cancer Research Centre (BZKF), Partner Site Munich, Munich, Germany; Department of Nuclear Medicine, School of Medicine and Health, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40318933