PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis
In brief
PSMA-guided nodal radiotherapy plus ADT achieves 74% 5-year metastasis-free survival
In a retrospective series of 179 men treated for nodal recurrence after prostatectomy, PSMA PET/CT-directed elective nodal radiotherapy combined with androgen-deprivation therapy yielded a 5-year metastasis-free survival of 74% among those with true biochemical recurrence. Concomitant ADT was the strongest predictor of success, while persistent PSA after surgery signaled poorer outcomes; toxicity data were not systematically captured.
- Journal
- European journal of nuclear medicine and molecular imaging (Q1)
- Published
- 4 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Samuel M Vorbach, Thomas Seppi, Giulia Santo, Irene Virgolini, Ute Ganswindt, Michael Keilholz, et al.
- PMID
- 42693211
- DOI
- 10.1007/s00259-026-08147-z
Why clinicians should know about it
- Picked for Urology (paper of the day, 6 September 2026): PSMA PET/CT‑guided salvage nodal radiotherapy outcomes after prostatectomy
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 5 September 2026): PSMA PET/CT‑guided salvage ENRT outcomes
Abstract
PURPOSE: PSMA PET/CT has transformed the detection of nodal recurrence after radical prostatectomy, yet real-world evidence on long-term outcomes of PSMA PET/CT-guided salvage elective nodal radiotherapy (ENRT) remains limited. This study evaluated oncological outcomes of PSMA PET/CT-guided salvage ENRT in a bi-institutional cohort with extended follow-up. METHODS: We retrospectively analysed 179 patients who received PSMA PET/CT-based ENRT for nodal recurrence after radical prostatectomy at two tertiary centres between 2014 and 2024. Patients with pelvic and/or paraaortic lymph node metastases were included. The primary endpoint was metastasis-free survival (MFS); secondary endpoints included biochemical progression-free survival (BPFS) and overall survival (OS). Survival outcomes were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox regression analysis. RESULTS: Of the 179 patients, 104 (58.1%) had true biochemical recurrence after radical prostatectomy, whereas 75 (41.9%) had PSA persistence. After a median follow-up of 60.3 months, 5-year MFS and BPFS rates were 74.3% and 62.3%, respectively, in patients with true biochemical recurrence, compared with 61.2% and 56.4% in the overall cohort. In multivariable analyses of the entire cohort, concomitant ADT was associated with improved MFS (HR 0.36, p < 0.001) and BPFS (HR 0.26, p < 0.001), compared with no ADT. PSA persistence after surgery was associated with worse outcomes (MFS: HR 2.72, p < 0.001; BPFS: HR 2.09, p = 0.005). CONCLUSION: PSMA PET/CT-guided salvage ENRT predominantly combined with ADT provides durable long-term disease control in patients with nodal recurrence in routine clinical practice. In patients with true recurrence after radical prostatectomy, the 5-year MFS rate was 74.3%, approaching outcomes reported in prospective trials. However, the absence of systematically collected clinician-assessed toxicity and patient-reported outcomes precludes a reliable assessment of treatment tolerability.
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.