(UroToday.com) The American Urological Association's 2025 Annual Meeting, between April 26 – 29, 2025, in Las Vegas, Nevada, was host to the Moderated Poster 13: Prostate Cancer: Staging Session. Dr. Claudia Kesch presented the moderated poster 13-03: Prostate cancer risk groups by PSMA-PET PROMISE (PPP): Results from an international multi-center registry study.
Dr. Kesch began her presentation by highlighting key milestones in the evolution of prostate cancer diagnostics, particularly the adoption of PSMA PET/CT imaging. She noted the introduction of Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) into clinical practice in 2012, which marked a significant advancement in disease detection. This innovation spurred further developments, including the establishment of the Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria in 2018 to standardize PSMA-PET reporting. Most recently, in 2024, the first prognostic nomograms based on PSMA-PET data—standardized using PROMISE (PPP1) were introduced using single-center datasets. The focus of the current study was to re-evaluate prognostic nomograms (PPP2) in a large, multi-center registry to refine a three-tier risk stratification model.
Dr. Kesch and colleagues conducted a study using a large multi-center registry. They queried data from male patients with prostate cancer across all disease stages who underwent PSMA PET/CT imaging between 2014 and 2021 at 20 hospitals across Europe, the United States, and Australia. Only patients with a minimum of 36 months of overall survival (OS) follow-up were included in the analysis.
The investigators developed the PPP2 nomograms using Cox regression models with LASSO penalty, incorporating potential predictors for OS. To compare the performance of PPP2 with the established clinical NCCN risk score, they utilized receiver operating characteristic (ROC) curves and calculated the area under the curve (AUC). Both visual PSMA PET/CT metrics based on molecular imaging TNM (miTNM) and quantitative metrics such as tumor volume (in mL)—were included, as illustrated in the graphic below.
A total of 6,128 male patients were included in the analysis, with 4,075 assigned to the development cohort and 2,053 to the validation cohort. There were 1,915 reported deaths (31.2%), with a median follow-up of 4.77 years (interquartile range [IQR], 3.38–6.44).
The PPP2 visual nomogram included extrapelvic lymph node metastases (miM1a), bone metastases (miM1b), organ metastases (miM1c), PSMA expression (SUVmax), and total lesion count. This model yielded a concordance index (C-index) of 0.812. Similarly, the quantitative nomogram, which replaced total lesion count with total tumor volume, achieved a slightly higher C-index of 0.821 for predicting overall survival probabilities at 3 and 5 years, as illustrated below.
Overall survival curves for all patients, as well as for subgroups including initial staging, biochemical recurrence (BCR), non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic hormone-sensitive prostate cancer (mHSPC), and metastatic castration-resistant prostate cancer (mCRPC), are shown below stratified by PPP2 risk groups. Notably, both the visual and quantitative PPP2 nomograms demonstrated strong discriminatory ability for overall survival across low-, intermediate-, and high-risk groups, with statistically significant separation (p < 0.0001) in all subgroups.
A head-to-head comparison of the prognostic accuracy of PPP2 versus NCCN risk groups was conducted in 3,638 patients with complete data. Notably, both the visual PPP2 nomogram (AUC 0.828) and the quantitative nomogram (AUC 0.837) significantly outperformed the NCCN risk classification, with both comparisons reaching statistical significance (p < 0.0001).
Dr. Kesch concluded her presentation with the following key take-home points:
- The PPP2 nomograms effectively stratify prostate cancer patients across all disease stages into low-, intermediate-, and high-risk groups for overall survival.
- PPP2 nomograms demonstrate superior prognostic accuracy compared to the NCCN risk classification.
- Longitudinal follow-up is ongoing within the PROMISE Registry (NCT06320223, promise-pet.org).
Presented by: Claudia Verena Kesch, MD, Department of Urology, University Hospital Essen, Essen, German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
Written by: Julian Chavarriaga, MD – Urologic Oncologist at Cancer Treatment and Research Center (CTIC) via Society of Urologic Oncology (SUO) Fellow at The University of Toronto. @chavarriagaj on Twitter during the American Urological Association's 2025 Annual Meeting, between April 26 – 29, 2025, in Las Vegas, NV.