Updated Prostate Cancer Risk Groups by Prostate-specific Membrane Antigen Positron Emission Tomography Prostate Cancer Molecular Imaging Standardized Evaluation (PPP2): Results from an International Multicentre Registry Study
- Author(s)
- Karpinski, MJ; Rahbar, K; Bögemann, M; Nikoukar, LR; Schäfers, M; Hoberück, S; Miederer, M; Hölscher, T; Rasul, S; Miszczyk, M; Lanfranchi, F; Bauckneht, M; Pfob, CH; Kind, F; Goffin, K; Hüsing, A; Kesch, C; Herrmann, K; Stuschke, M; Gafita, A; Hüsing, J; Calais, J; Hofman, MS; Hope, TA; Miksch, J; Soeterik, TFW; Di Giorgio, A; Farolfi, A; Bjartell, A; Trägårdh, E; Unterrainer, LM; Holzgreve, A; Sheikh, GT; Rauscher, I; Eiber, M; Hadaschik, BA; Fendler, WP;
- Journal Title
- European Urology
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND AND OBJECTIVE: 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. METHODS: 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). KEY FINDINGS AND LIMITATIONS: 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. CONCLUSIONS AND CLINICAL IMPLICATIONS: 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).
- Keywords
- Overall survival; Prognosis; Prostate Cancer Molecular Imaging Standardized Evaluation nomogram; Prostate cancer; Prostate-specific membrane antigen positron emission tomography
- Department(s)
- Cancer Imaging
- Publisher's Version
- https://doi.org/10.1016/j.eururo.2025.04.017
- Open Access at Publisher's Site
https://doi.org/10.1016/j.eururo.2025.04.017- Terms of Use/Rights Notice
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Creation Date: 2025-06-02 04:28:18
Last Modified: 2025-06-02 04:28:43