Fig. 2.

Lifetime state transition model used for the different scenarios. The model consists of six health states where patients can find themselves in during follow-up: ‘No evidence of disease after treatment of N0 disease’ (NEOD-N0), ‘No evidence of disease after treatment of N1 disease’ (NEOD-N1), ‘Salvage’, ‘Palliative’, ‘False Palliative’ and ‘Cancer death’. The NEOD states were used to reflect patients who were treated curatively. It was assumed that patients in the NEOD-N0 state would be fully cured and stay there till death. Patients in NEOD-N1 state were assumed to be at risk for biochemical recurrence (BCR), when BCR occurs they transfer towards salvage or directly towards palliative. The salvage state was designed to reflect the period of salvage initialized after BCR would occur. After salvage treatment, they either stay in salvage state or transit to palliative state. The palliative state reflects the long-term palliative period for prostate cancer patients. In this period, no curative treatments are initialized. The false palliative state was designed to mimic the palliative state of patients who are falsely being diagnosed for palliative treatment by [⁶⁸Ga]Ga-PSMA-11 PET/CT. Patients in the palliative state and the false palliative state would stay there until death. Prostate cancer-related death could only occur in the palliative state and the false palliative state. All patients could transit to non-prostate cancer-related death from every state (these lines are hidden)