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Review
. 2025 Sep 1;35(5):506-509.
doi: 10.1097/MOU.0000000000001291. Epub 2025 Apr 23.

Prostate-specific membrane antigen positron-emission tomography for novel risk-stratification of biochemical recurrence

Madeleine J Karpinski  1 , Claudia Kesch  2 , Boris A Hadaschik  2 , Wolfgang P Fendler  1
Affiliations
Review

Prostate-specific membrane antigen positron-emission tomography for novel risk-stratification of biochemical recurrence

Madeleine J Karpinski et al. Curr Opin Urol. .

Abstract

Purpose of review: The variety of prostate cancer aggressiveness in patients with biochemical recurrence (BCR) leads to the unmet need of accurate risk stratification. This review examined the recently published risk stratification tool using prostate-specific membrane antigen positron-emission tomography (PSMA-PET) compared to the risk categories by European Association of Urology (EAU).

Recent findings: The risk stratification by EAU was proposed for patients with BCR, including the doubling time of the prostate-specific-antigen and Gleason score as predictors for survival. Although stratification into low- vs. high-risk groups reached significant differences in the external validation, C-indices determined moderate discriminative ability and the need to improve the EAU risk categories. PSMA-PET was recently validated as prognostic biomarker and PSMA-PET standardized by Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) metrics were combined to create a visual and a quantitative nomogram to predict overall survival.

Summary: The unmet need to improve risk stratification for prostate cancer patients experiencing BCR was addressed with PSMA-PET PROMISE (PPP) nomograms. Although PPP nomograms are not applied for individual patient counselling yet, they can be used additionally to EAU risk categories.

Keywords: European Association of Urology risk categories; biochemical recurrence; prostate-specific membrane antigen positron-emission tomography; prostate-specific membrane antigen positron-emission tomography PROMISE nomograms; risk stratification.

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