{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:40:06Z","timestamp":1751373606412,"version":"3.41.0"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prostate\u2010specific membrane antigen (PSMA) PET\/CT has been established as the standard imaging technique after biochemical recurrence (BCR) of prostate cancer (PCa). However, its availability is not widespread, thus, patient selection criteria are necessary. For this reason, a European nomogram was recently developed with the intention of helping to predict and identify those patients with BCR at high risk for a positive PSMA PET\/CT. The aim of our study was to test the external validity of this nomogram in a large regional cohort of patients and its impact as a selective tool for patients with BCR who should undergo a PSMA PET\/CT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>A multicenter, observational, and retrospective study to validate, calibrate, and readjust the European PSMA PET\/CT positivity prediction nomogram in a cohort of patients with BCR after radical treatments for localized PCa. Clinical and demographic data were analyzed. We evaluated the detection rate of PSMA PET\/CT, the association of different variables with a positive PSMA PET\/CT, and the accuracy of the nomogram, summarized in an ROC curve and a clinical decision curve. The nomogram was then modified and improved for our cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A cohort of 413 patients with BCR undergoing PSMA PET\/CT was evaluated. Median age, PSA, and PSAdt were 66 years, 0.52\u2009ng\/mL, and 7 months, respectively. Median time to BCR was 34 months and the predominant ISUP was 3 (31%). Most patients underwent radical prostatectomy (88%). PSMA PET\/CT was positive in 67% of patients, with pelvic involvement in 32% and 24% positivity outside the pelvis. The independent variables associated with a positive PSMA PET\/CT were PSA value (OR: 1.94 (1.2\u20133.19), with a PSA level\u2009\u2265\u20090.5\u2009ng\/dL), and a PSA persistence after primary treatment (OR 2.95 (95% CI 1.37\u20137.14)). The original nomogram had a low predictive ability, with an AUC of 0.57 (95% CI: 0.52\u20130.62). It was necessary to adjust and calibrate this to obtain a novel nomogram with an AUC of 0.84 (95% CI 0.70\u20130.98). The DCA showed a greater net benefit from the use of this nomogram at intermediate threshold levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The nomogram showed a low predictive ability in our external validation. Nevertheless, our novel nomogram demonstrated a moderate\u2010high predictive ability, which could thus optimize the selection of BCR patients who are candidates for PSMA PET\/CT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pros.24910","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T05:25:27Z","timestamp":1746595527000},"page":"1016-1023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multicenter External Validation and Optimization of a Proposed Nomogram for Prostate\u2010Specific Membrane Antigen PET\/CT Accuracy in Biochemical Recurrence"],"prefix":"10.1002","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-4910","authenticated-orcid":false,"given":"Laura Chamorro","family":"Castillo","sequence":"first","affiliation":[{"name":"Urology Department Reina Sofia University Hospital, IMIBIC, UCO C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In\u00e9s Rivero","family":"Belench\u00f3n","sequence":"additional","affiliation":[{"name":"Urology and Nephrology Department Virgen del Roc\u00edo University Hospital, Biomedical Institute of Seville (IBiS)\/Virgen del Roc\u00edo University Hospital\/CSIC\/University of Seville Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio Puche","family":"Sanz","sequence":"additional","affiliation":[{"name":"Urology Department Hospital Universitario Virgen de las Nieves, Biosanitary Research ibs. GRANADA Granada Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc\u00edo Saiz","family":"Marenco","sequence":"additional","affiliation":[{"name":"Urology Department Jerez University Hospital, Jerez C\u00e1diz Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Victoria","family":"Ojeda Claro","sequence":"additional","affiliation":[{"name":"Urology Department Puerta del Mar University Hospital, C\u00e1diz C\u00e1diz Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N\u00e9stor S\u00e1nchez","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Urology Department Malaga Regional University Hospital M\u00e1laga Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Medina L\u00f3pez","sequence":"additional","affiliation":[{"name":"Urology and Nephrology Department Virgen del Roc\u00edo University Hospital, Biomedical Institute of Seville (IBiS)\/Virgen del Roc\u00edo University Hospital\/CSIC\/University of Seville Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Ju\u00e1rez Soto","sequence":"additional","affiliation":[{"name":"Urology Department Jerez University Hospital, Jerez C\u00e1diz Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Luis","family":"\u00c1lvarez Ossorio","sequence":"additional","affiliation":[{"name":"Urology Department Puerta del Mar University Hospital, C\u00e1diz C\u00e1diz Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Garc\u00eda Galisteo","sequence":"additional","affiliation":[{"name":"Urology Department Malaga Regional University Hospital M\u00e1laga Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Carrasco Valiente","sequence":"additional","affiliation":[{"name":"Urology Department Reina Sofia University Hospital, IMIBIC, UCO C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernardo Herrera","family":"Imbroda","sequence":"additional","affiliation":[{"name":"Urology Department Virgen de la Victoria University Hospital, M\u00e1laga B\u201011 Genitourinary Oncology Translational Research Group, Biomedical Institute of Malaga IBIMA\u2010Bionand Platform M\u00e1laga Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Moreno Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Urology Department Ja\u00e9n University Hospital Ja\u00e9n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Antonio Vallejo","family":"Casas","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Reina Sofia University Hospital, IMIBIC, UCO C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Virgen de las Nieves University Hospital, Instituto de Investigaci\u00f3n Biosanitaria ibs. GRANADA Granada Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adri\u00e1n Santiago","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Bioinformatics and Biostatistics Unit, Instituto Maim\u00f3nides de Investigaci\u00f3n Biom\u00e9dica de C\u00f3rdoba (IMIBIC) C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Pablo Campos","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Urology Department Reina Sofia University Hospital, IMIBIC, UCO C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8753-3306","authenticated-orcid":false,"given":"Enrique","family":"G\u00f3mez G\u00f3mez","sequence":"additional","affiliation":[{"name":"Urology Department Reina Sofia University Hospital, IMIBIC, UCO C\u00f3rdoba Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"PSMAAND Collaborators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.09.046"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23139"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.5.1499"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.04.035"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.09.004"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.01.049"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-017-3455-6"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.06.021"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-018-4066-4"},{"issue":"2","key":"e_1_2_11_11_1","first-page":"231","article-title":"Biochemical Recurrence in Prostate Cancer: The European Association of Urology Prostate Cancer Guidelines Panel Recommendations. 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