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PSMA-PET PPP3 nomograms for prostate cancer survival risk assessment

An international, retrospective, registry-based study reports externally validated PPP3 nomograms for 3-, 5-, and 7-year overall survival, with superior prediction accuracy versus NCCN risk scores and, in specific subgroups, versus EAU and GAFITA scores.

  • Madeleine J Karpinski, MSc; Caner Civan, MD; Isabel Rauscher, MD; Osman Güven, MD; Matthias Eiber, MD; Sebastian Hoberück, MD; et al.

  • March 1, 2026

  • The Lancet Oncology
  • The Lancet Oncology, Volume 27, Issue 4, Pages 480–490
  • 10.1016/S1470-2045(26)00016-1

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Evidence before this study

We searched PubMed and MEDLINE for peer-reviewed, original studies published in English from database inception to July 2, 2025, using following terms: “PSMA”, “PET/CT”, “PROMISE”, “overall survival”, “prognosis”, and “nomogram”. We identified our previous multicentre, retrospective study on combining prostate-specific membrane antigen (PSMA)-PET and Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) to redefine disease stage and risk in patients with prostate cancer and an international registry study on updated prostate cancer risk groups by PSMA-PET molecular imaging standardised evaluation.

Added value of this study

The PROMISE PET registry was initiated as a far-reaching global study, with intended duration until 2035 (). With continuous data updates and increased enrolment, we aim to achieve mature overall survival data for accurate predictions. Since PPP1 and PPP2, we were able to more than double enrolment and increase follow-up times by an average of 27·9%. In this study, we assess real-world data from a large, international, multicentre cohort to create new PPP3 nomograms for 3-year, 5-year, and 7-year risk assessments of pan-stage prostate cancer. We validated PPP3 nomograms externally and reached superior prediction accuracy compared with the established clinical risk scores: National Comprehensive Cancer Network risk scores in all disease subgroups, European Association of Urology risk scores in the subgroup with biochemically recurrent prostate cancer, and GAFITA nomogram risk scores in the subgroup with metastatic hormone-sensitive prostate cancer.

Implications of all the available evidence

PSMA-PET reported by PROMISE is an independent prognostic biomarker of prostate cancer survival outcomes, which can be used for clinical trials and routine practice.

Source: The Lancet Oncology

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