Oncological Outcomes of Robot-assisted PSMA-guided Salvage Surgery in Recurrent Prostate Cancer: Insights from the Prospective TRACE-I Trial
In brief
PSMA-guided robotic surgery lowered PSA in 93% of recurrent prostate cancer patients
In a prospective series of 30 men with biochemical recurrence, robot-assisted PSMA radioguided surgery produced a PSA decline in 93% and achieved undetectable PSA (<0.2 ng/ml) in two-thirds of cases. One-year biochemical progression-free survival was only 40%, but the technique delayed further therapy for over half of patients at two years. Careful selection of candidates appears essential for meaningful benefit.
- Journal
- European urology focus (Q1)
- Published
- 29 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Lotte G Zuur, Hilda A de Barros, Vera A Ottens, Anne-Claire Berrens, Matthias N van Oosterom, Maarten L Donswijk, et al.
- PMID
- 42668258
- DOI
- 10.1016/j.euf.2026.07.005
Why clinicians should know about it
- Picked for Urology (paper of the day, 2 September 2026): Robot-assisted PSMA-guided salvage surgery outcomes
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 30 August 2026): PSMA‑guided salvage surgery, imaging‑guided intra‑op guidance
Abstract
BACKGROUND: Prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) is an emerging technique providing real-time intraoperative guidance. The prospective TRACE-I trial demonstrated that robot-assisted 99mtechnetium-PSMA-Investigation & Surgery-RGS ([99mTc]Tc-PSMA-I&S-RGS) using a DROP-IN gamma probe is feasible and safe in recurrent prostate cancer (PCa). OBJECTIVE: To report the oncological outcmes of a post hoc analysis of the prospective TRACE-I trial cohort. DESIGN, SETTING, AND PARTICIPANTS: TRACE-I prospectively enrolled 30 patients with biochemical recurrence (prostate-specific antigen (PSA) ≥0.2 ng/ml after radical prostatectomy (RP) or ≥2 ng/ml above nadir after radiotherapy (RT) and ≤3 pelvic recurrences (nodal and/or local) on PSMA-positron emission tomography/computed tomography (PET/CT; 2020-2023). INTERVENTION: Patients underwent single-photon emission CT/CT and then robot-assisted PSMA-RGS. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Oncological outcomes were biochemical progression (PSA ≥0.2 ng/ml after RP or ≥2 ng/ml above nadir after RT), radiological recurrence on PSMA-PET/CT, and time to salvage therapy. Biochemical progression-free survival (bPFS), distant metastasis-free survival (dMFS), and therapy-free survival (TFS) were analysed using Kaplan-Meier and univariable Cox regression. RESULTS AND LIMITATIONS: Among 30 patients (19 RP, 9 RT, and 2 RP + RT), the median age was 68 yr, and the median PSA at RGS was 1.02 ng/ml (interquartile range, 0.46-2.86), 28 (93%) showed PSA decline after RGS, and 20 (66%) reached PSA <0.2 ng/ml or PSA nadir. The 1- and 2-yr bPFS were 40% and 30%; 2-yr dMFS and TFS were 62% and 58%, respectively. Recurrences were pelvic in 37% and distant in 40%. Limitations include single-centre design and small sample size. CONCLUSIONS: PSMA-RGS in the robotic setting for recurrent PCa shows an early PSA decline in almost all patients. Although biochemical progression after PSMA-RGS is common, PSMA-RGS presents an opportunity to prolong bPFS and TFS in a selection of patients. PATIENT SUMMARY: We updated outcomes from TRACE-I patients with recurrent prostate cancer. We found that PSMA-guided surgery led to PSA declines in most patients and delayed disease progression in some, but careful patient selection is essential.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.