Raul Tirinescu, Oncology Specialist at M Hospital Bucharest shared a post on LinkedIn:
“PSMA PET/CT – guided salvage radiotherapy: clinically meaningful long-term outcomes after prostatectomy.
PSMA PET/CT is increasingly moving from a “better detector” to a treatment-shaping tool in biochemical recurrence after radical prostatectomy. A single-center retrospective cohort from UCLA (n=113) evaluated patients with first biochemical recurrence, restaged with PSMA PET/CT and treated with salvage radiotherapy (sRT) close to the time of imaging, with long-term follow-up (median 59.4 months).
Key outcomes reported:
- Median PFS: 49.2 months; 2-year PFS: 72.6%; 5-year PFS: 48.7%
- Distant metastasis–free survival: median 76.4 months; 2-year: 85.8%; 5-year: 72.4%
- Overall survival: median not reached; 5-year OS: 97.1%
Beyond sensitivity, PSMA PET/CT appeared to provide clinically actionable risk stratification:
- Patients with negative PSMA PET/CT (T0N0M0) had particularly favorable outcomes (5-year PFS ~62%), supporting timely sRT even when disease is not visualized.
- Whole-pelvis RT (WPRT) showed signal of benefit mainly in locally recurrent (TrN0M0) disease, with no clear advantage in the T0N0M0 subgroup.
- In patients with nodal or distant uptake on PSMA PET/CT, the addition of ADT correlated with improved PFS, aligning treatment intensity with disease biology.
These data suggest that PSMA PET/CT may help tailor radiation volumes and systemic intensification (e.g., ADT) rather than merely detect disease earlier. In real-world practice, this supports a more precision-guided salvage strategy-treat what is seen, and treat according to the biological risk that PSMA PET/CT reveals.
Important limitations must be acknowledged: retrospective design, absence of a randomized comparator, and heterogeneity in treatment approaches introduce potential selection and stage-migration biases. Thus, the findings are hypothesis-generating and reinforce-rather than replace-the need for prospective validation. Ongoing trials (e.g., PSMA-SRT, PEACE-V/STORM, ADOPT, PSICHE) will be critical to define the optimal integration of PSMA PET/CT into sRT decision-making.
Take-home message: PSMA PET/CT–guided sRT is associated with favorable long-term oncologic outcomes and appears to meaningfully inform risk-adapted radiation and systemic therapy decisions in post-prostatectomy biochemical recurrence.
Study credit and source: Nikitas J. et al. Journal of the National Comprehensive Cancer Network (JNCCN), 2026; doi: 10.6004/jnccn.2025.7102. Summary and reporting via Cancer Network (fact-checked editorial coverage).”
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