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Cohort-derived nomogram, externally validated, estimates ADT-free survival after MDT in PSMA PET–staged prostate cancer

Developed in a multicentric cohort of 586 patients and externally validated in 131 independent patients, the model stratifies men with metachronous oligometastatic prostate cancer treated with MDT into risk groups for 1- and 2-year ADT-free survival.

  • Timo F W Soeterik, PhD; Marcin Miszczyk, MD; Max Peters, PhD; Mateusz Bilski, MD; Giulio Francolini, MD; Pietro Garlatti, MD; et al.

  • February 16, 2026

  • The Lancet Oncology
  • The Lancet Oncology, Volume 27, Issue 3, Pages 383–392
  • 10.1016/S1470-2045(25)00717-X

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Evidence before this study

We searched PubMed from database inception to Sept 1, 2025, without any language restrictions, for original studies reporting prognostic factors or nomograms for metastasis-directed therapy (MDT) in oligorecurrent prostate cancer staged with prostate-specific membrane antigen (PSMA) PET, using the terms: (“metastas*s directed” OR “stereotactic body radiotherapy” OR “stereotactic ablative radiotherapy”) AND (“metasta*” OR “oligometasta*”) AND “prostate cancer”. 11 studies were identified, most reporting predictors of biochemical or progression-free survival after MDT but not explicitly addressing deferral of androgen deprivation therapy (ADT). Vogel and colleagues developed a prognostic risk classification for biochemical relapse-free survival after PSMA PET-guided MDT, but this did not estimate ADT-free survival and was not designed as a nomogram. No comprehensive prognostic models predicting ADT-free survival after MDT in the PSMA PET era are currently available.

Added value of this study

To our knowledge, this is the first externally validated nomogram and risk classification system predicting ADT-free survival in PSMA PET–staged men with metachronous oligometastatic prostate cancer treated with MDT. Using a multicentric cohort of 586 patients, validated in 131 independent patients, we developed a model based on routinely available variables that stratifies patients into low-risk, intermediate-risk, and high-risk groups. The model showed good calibration, consistent performance across cohorts, enabling reliable estimation of 1-year and 2-year ADT-free survival.

Implications of all the available evidence

This nomogram enables personalised treatment decisions by identifying patients most likely to achieve durable systemic treatment-free intervals with MDT alone, sparing ADT-related toxicities, versus those unlikely to benefit from treatment de-escalation and who might require early intensification. It complements recent trial findings and provides a pragmatic risk-adapted tool for clinical practice and a stratification factor for future trials. To facilitate implementation, the model is made available as a web-based calculator.

Source: The Lancet Oncology

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