PSMA PET/CT-guided sRT + field/ADT tailoring delivers 97% 5-year OS after post-RP recurrence

PSMA PET/CT is a prostate cancer–specific molecular imaging modality targeting PSMA to localize recurrence and guide salvage radiotherapy (sRT) after radical prostatectomy. In this retrospective analysis of 5 prospective PSMA PET/CT cohorts (2016–2021), 113 men treated with PSMA PET/CT–guided sRT at first biochemical recurrence (median PSA 0.4ng/mL) had median PFS 49.2 months and median freedom from distant progression 76.4 months; 5-year OS was 97.1% at a median 59.4-month follow-up, with 50.4% progressing overall. Exploratory subgroup signals suggested whole-pelvis RT improved PFS in TrN0M0 (aHR 0.12; p=0.035) and ADT improved PFS in N1/M1 (aHR 0.37; p=0.024)—directionally consistent with randomized evidence that adding short-course ADT to salvage prostate-bed RT improves PFS (e.g., GETUG-AFU 16: 5-year PFS 80% vs 62%; HR 0.50) and that longer antiandrogen intensification can improve long-term outcomes in higher-risk salvage settings (RTOG 9601).