ArticleFrontiers in oncology2026
PSMA-guided management of recurrent post-prostatectomy patients: a sub-analysis of a prospective single-center study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: The advent of prostate-specific membrane antigen - positron emission tomography (PSMA-PET) imaging influences prostate cancer (PCa) salvage radiotherapy (SRT) decision-making, especially in biochemical recurrence (BCR) with low PSA. This study evaluates the impact of PSMA-PET on recurrent post-prostatectomy patients treated with radiotherapy (RT) ± hormonal therapy (HT). Materials and methods: In a prospective, observational study (2016-2020), 103 hormone-sensitive post-prostatectomy pN0-pNx PCa patients with proven BCR were analyzed. PSMA-positive patients received tailored treatments based on lesion sites, ranging from prostate bed (P-bed) SRT abort, metastases-directed therapy, to systemic therapy. PSMA-negative patients were mainly treated with SRT. Primary objectives included PSMA-based management changes and biochemical progression-free survival (bPFS) comparison. Results: PSMA-PET was positive in 28.1% (29/103) at a median PSA of 0.5 ng/mL. The most common relapse sites were bones and pelvic lymph nodes. Among positive PSMA-PET patients, the P-bed abort rate was 58.6% (17/29 patients). Excluding patients with PSMA-positive uptake solely in the P-bed (7 patients), the rate of P-bed abort was 77.3% (17/22 patients). Management was altered in 75.8% of PSMA-positive and 21.3% overall. Most PSMA-positive lesions were managed with SBRT, either as a standalone treatment or within combined-modality approaches: SBRT was delivered to 50% of nodal recurrences (including both N1 and M1a cases) and to 100% of bone lesions. At 5 years, bPFS was 66.8% in PSMA-negative patients (undergoing SRT+/-HT) vs. 26.7% in PSMA-positive patients (any treatment). Conclusion: PSMA-PET led to management changes in nearly one-third of post-prostatectomy recurrent PCa, notably affecting RT strategies and systemic therapy. Emerging evidence suggests that treatment intensification based on PSMA-PET findings may improve patient outcomes compared to de-intensified approaches. The impact on outcomes awaits validation from ongoing prospective randomized trials.
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