In a study reported in The Lancet Oncology, Karpinski et al developed a new prostate cancer risk classification using PSMA-PET Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE; PPP) nomograms (PPP3) to provide prognostic values for overall survival at 3, 5, and 7 years.
Study Details
The international, retrospective, registry-based cohort study used data from patients in the PROMISE PET registry with any-stage disease and ongoing overall survival follow-up. Patients included in the analysis underwent prostate-specific membrane antigen positron-emission tomography (PSMA-PET) between December 2012 and June 2024. Patients with neuroendocrine pattern or metastasized or disseminated malignancy other than prostate cancer were excluded. A total of 11,154 patients were split 2:1 into a development cohort (n = 7,253) and a validation cohort (n = 3,901). The PPP3 nomograms were created based on Cox regression models with least absolute shrinkage and selection operator penalty to prognosticate 3-, 5-, and 7-year overall survival. A simplified risk-stratification table was created based on the visual PPP3 nomograms.
Key Findings
Median follow-up to censoring or death was 4.9 years (interquartile range = 3.5–6.6 years).
Clinical disease group and PROMISE metrics were combined into visual and quantitative PPP3 nomograms for 3-, 5-, and 7-year survival. For the visual nomogram, C-index values were 0.83 (95% confidence interval [CI] = 0.82–0.84) in the development cohort and 0.83 (95% CI = 0.82–0.84) in the validation cohort. For the quantitative nomogram, C-index values were 0.83 (95% CI = 0.82–0.84) in the development cohort and 0.84 (95% CI = 0.82–0.85) in the validation cohort.
Comparison between the visual nomogram and the simplified risk-stratification table showed no significant difference in prognostic accuracy (receiver operating characteristic AUC = 0.78, 95% CI = 0.78–0.78, P = .36).
As stated by the investigators, “Both the nomograms and the simplified risk stratification table exhibited accuracy equal or superior to established clinical risk scores [eg, International Staging Collaboration for Cancer of the Prostate, European Association of Urology, National Comprehensive Cancer Network].”
They concluded: “We present new risk nomograms by PROMISE along with a simple table to prognosticate 3-year, 5-year, and 7-year overall survival in prostate cancer. PROMISE and PPP3 assessments are freely available online (promise-pet.org) for global implementation.”
Wolfgang P. Fendler, MD, of the Department of Nuclear Medicine, University Hospital Essen, Essen, Germany, is the corresponding author for The Lancet Oncology article.
DISCLOSURE: The study was funded by the German Research Foundation, Prostate Cancer Foundation, Innovative Health Initiative Joint Undertaking, Novartis, AstraZeneca, and Amgen. For full disclosures of the study authors, visit thelancet.com.
