{
  "abstract": "The predictive value of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) for extraprostatic extension (EPE) in prostate cancer remains unclear. We assessed whether adding PSMA PET/CT to magnetic resonance imaging (MRI) and clinical factors improves side-specific EPE prediction. Patients undergoing PSMA PET/CT and MRI before radical prostatectomy were analysed retrospectively. The endpoint was side-specific EPE (≥pT3a). Predictors were selected by backward elimination, and the final nomogram was fitted using generalised estimating equations to account for clustering of lobes within patients. Discrimination, calibration, and net benefit were assessed, with external validation in an independent single-centre cohort. Development and validation cohorts included 801 and 287 lobes. The final model comprised prostate-specific antigen density (odds ratio [OR] 1.54 [95% confidence interval {CI} 0.94-2.50]; biopsy International Society of Urological Pathologists grade group (2 vs benign/1: OR 2.01 [95% CI 1.27-3.19]; 3 vs benign/1: OR 3.82 [95% CI 2.30-6.35]; 4 vs benign/1: OR 2.50 [95% CI 1.54-4.08]; 5 vs benign/1: OR 4.05 [95% CI 2.18-7.53]), MRI T-stage (organ-confined with a lesion [OC] vs organ-confined with no lesion [NL]: OR 1.31 [95% CI 0.86-1.99]; EPE vs NL: OR 4.11 [95% CI 2.56-6.60]), PSMA T-stage (OC vs NL: OR 1.67 [95% CI 1.07-2.61]; EPE vs NL: OR 2.59 [95% CI 1.49-4.49]), PSMAtotal (OR 1.72 [95% CI 1.33-2.23]). In development, the PSMA-MRI nomogram showed superior discrimination (area under the receiver operating characteristic curve [AUC] 0.80 vs 0.71, p < 0.001). On validation, the updated model demonstrated discrimination comparable to the reference model (AUC 0.85 vs 0.86, p = 0.9), with minor risk overestimation and similar net clinical benefit. Limitations include a relatively small validation cohort. The PSMA-MRI nomogram appeared to outperform the MRI-only model in development, but this was not confirmed in validation, indicating limited, context-dependent incremental value.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.",
    "Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands.",
    "Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.",
    "Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.",
    "Department of Urology, Indiana University Medical Center, Indianapolis, IN, USA.",
    "Department of Radiology and Imaging Sciences, Indiana University Medical Center, Indianapolis, IN, USA.",
    "Department of Urology, University Hospital Essen, Essen German Cancer Consortium (DKTK) University Hospital Essen, Essen, Germany.",
    "Department of Nuclear Medicine, University Hospital Essen, Essen German Cancer Consortium (DKTK), Germany.",
    "S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.",
    "Department of Nuclear Medicine and PET, Hong Kong Sanatorium and Hospital, Hong Kong, China.",
    "Department of Surgery, Oncology, and Gastroenterology, Urological Unit, University of Padova, Padova, Italy.",
    "Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.",
    "Division of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy.",
    "Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy.",
    "Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.",
    "Collegium Medicum-Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland.",
    "Department of Urology, Medical University of Silesia, Zabrze, Poland.",
    "Division of Surgery & Interventional Science, University College London, London, UK.",
    "Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.",
    "Department of Urology, Semmelweis University, Budapest, Hungary.",
    "Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.",
    "Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.",
    "Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.",
    "Division of Urology, Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Italy.",
    "Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 30,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Vera Sweere"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alexandra Bruins Slot"
    },
    {
      "affs": [
        0
      ],
      "name": "Joris G Heetman"
    },
    {
      "affs": [
        2
      ],
      "name": "Rick Hermsen"
    },
    {
      "affs": [
        0
      ],
      "name": "Lieke Wever"
    },
    {
      "affs": [
        3
      ],
      "name": "Jules Lavalaye"
    },
    {
      "affs": [
        2
      ],
      "name": "Maarten Vinken"
    },
    {
      "affs": [
        4
      ],
      "name": "Clinton D Bahler"
    },
    {
      "affs": [
        5
      ],
      "name": "Mark Tann"
    },
    {
      "affs": [
        6
      ],
      "name": "Claudia Kesch"
    },
    {
      "affs": [
        7
      ],
      "name": "Tugce Telli"
    },
    {
      "affs": [
        7
      ],
      "name": "Wolfgang P Fendler"
    },
    {
      "affs": [
        8
      ],
      "name": "Peter Ka-Fung Chiu"
    },
    {
      "affs": [
        9
      ],
      "name": "Sam Kwan Kit Wu"
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    {
      "affs": [
        10
      ],
      "name": "Fabio Zattoni"
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    {
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        11,
        12
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      "name": "Laura Evangelista"
    },
    {
      "affs": [
        13
      ],
      "name": "Francesco Ceci"
    },
    {
      "affs": [
        14,
        15
      ],
      "name": "Marcin Miszczyk"
    },
    {
      "affs": [
        14,
        16,
        17
      ],
      "name": "Paweł Rajwa"
    },
    {
      "affs": [
        14,
        18
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      "name": "Akihiro Matsukawa"
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    {
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        14,
        19
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      "name": "Tamás Fazekas"
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    {
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        20
      ],
      "name": "Francesco Barletta"
    },
    {
      "affs": [
        20
      ],
      "name": "Alberto Briganti"
    },
    {
      "affs": [
        20
      ],
      "name": "Giorgio Gandaglia"
    },
    {
      "affs": [
        21
      ],
      "name": "Jean-Paul A Van Basten"
    },
    {
      "affs": [
        0
      ],
      "name": "Harm H E Van Melick"
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    {
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        22
      ],
      "name": "Roderick C N Van den Bergh"
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    {
      "affs": [
        23
      ],
      "name": "Giancarlo Marra"
    },
    {
      "affs": [
        0
      ],
      "name": "Matthijs J V Scheltema"
    },
    {
      "affs": [
        0,
        24
      ],
      "name": "Timo F W Soeterik"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8g903zp3m3gtt.bib",
  "cited_by": 0,
  "doi": "10.1016/j.euros.2026.10.003",
  "fulltext_url": "https://europepmc.org/articles/PMC13743373",
  "id": "8g903zp3m3gtt",
  "issns": [
    "2666-1691",
    "2666-1683"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999552",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2748|Prostate Cancer Diagnosis and Treatment"
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  "openalex": "W7224288005",
  "pdf_url": "https://europepmc.org/articles/PMC13743373?pdf=render",
  "pmcid": "PMC13743373",
  "pmid": "42999552",
  "published": "2026-10-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/8g903zp3m3gtt.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42999552",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999552"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2748|Prostate Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "Development and External Validation of an Updated Nomogram Including Both MRI and Local PSMA PET/CT Information for the Prediction of Side-specific Extraprostatic Extension in Patients Treated with Radical Prostatectomy.",
  "title_text": "Development and External Validation of an Updated Nomogram Including Both MRI and Local PSMA PET/CT Information for the Prediction of Side-specific Extraprostatic Extension in Patients Treated with Radical Prostatectomy.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/8g903zp3m3gtt",
  "venue": "European urology open science",
  "versions": []
}