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.
25 affiliations
- 1Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
- 2Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- 3Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
- 4Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
- 5Department of Urology, Indiana University Medical Center, Indianapolis, IN, USA.
- 6Department of Radiology and Imaging Sciences, Indiana University Medical Center, Indianapolis, IN, USA.
- 7Department of Urology, University Hospital Essen, Essen German Cancer Consortium (DKTK) University Hospital Essen, Essen, Germany.
- 8Department of Nuclear Medicine, University Hospital Essen, Essen German Cancer Consortium (DKTK), Germany.
- 9S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
- 10Department of Nuclear Medicine and PET, Hong Kong Sanatorium and Hospital, Hong Kong, China.
- 11Department of Surgery, Oncology, and Gastroenterology, Urological Unit, University of Padova, Padova, Italy.
- 12Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- 13Division of Nuclear Medicine, IRCCS Humanitas Research Hospital, Milan, Italy.
- 14Division of Nuclear Medicine and Theranostics, IEO European Institute of Oncology, IRCCS, Milan, Italy.
- 15Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- 16Collegium Medicum-Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland.
- 17Department of Urology, Medical University of Silesia, Zabrze, Poland.
- 18Division of Surgery & Interventional Science, University College London, London, UK.
- 19Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
- 20Department of Urology, Semmelweis University, Budapest, Hungary.
- 21Division 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.
- 22Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
- 23Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
- 24Division of Urology, Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Italy.
- 25Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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.
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BibTeX
@article{sweere2026development,
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.}},
author = {Vera Sweere and Alexandra Bruins Slot and Joris G Heetman and Rick Hermsen and Lieke Wever and Jules Lavalaye and Maarten Vinken and Clinton D Bahler and Mark Tann and Claudia Kesch and Tugce Telli and Wolfgang P Fendler and Peter Ka-Fung Chiu and Sam Kwan Kit Wu and Fabio Zattoni and Laura Evangelista and Francesco Ceci and Marcin Miszczyk and Paweł Rajwa and Akihiro Matsukawa and Tamás Fazekas and Francesco Barletta and Alberto Briganti and Giorgio Gandaglia and Jean-Paul A Van Basten and Harm H E Van Melick and Roderick C N Van den Bergh and Giancarlo Marra and Matthijs J V Scheltema and Timo F W Soeterik},
journal = {European urology open science},
year = {2026},
month = oct,
doi = {10.1016/j.euros.2026.10.003},
url = {https://europepmc.org/article/MED/42999552},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Vera Sweere
AU - Alexandra Bruins Slot
AU - Joris G Heetman
AU - Rick Hermsen
AU - Lieke Wever
AU - Jules Lavalaye
AU - Maarten Vinken
AU - Clinton D Bahler
AU - Mark Tann
AU - Claudia Kesch
AU - Tugce Telli
AU - Wolfgang P Fendler
AU - Peter Ka-Fung Chiu
AU - Sam Kwan Kit Wu
AU - Fabio Zattoni
AU - Laura Evangelista
AU - Francesco Ceci
AU - Marcin Miszczyk
AU - Paweł Rajwa
AU - Akihiro Matsukawa
AU - Tamás Fazekas
AU - Francesco Barletta
AU - Alberto Briganti
AU - Giorgio Gandaglia
AU - Jean-Paul A Van Basten
AU - Harm H E Van Melick
AU - Roderick C N Van den Bergh
AU - Giancarlo Marra
AU - Matthijs J V Scheltema
AU - Timo F W Soeterik
PY - 2026
DA - 2026/10/29
JO - European urology open science
DO - 10.1016/j.euros.2026.10.003
UR - https://europepmc.org/article/MED/42999552
AB - 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.
SN - 2666-1691
SN - 2666-1683
ER -