PSMA PET/CT scans predict progression-free survival and guide personalized treatment strategies for recurring prostate cancer.

Researchers at the University of California, Los Angeles (UCLA, CA, USA) have reported insights into the role of prostate-specific membrane antigen (PSMA) PET/CT scans in guiding treatment for prostate cancer patients with rising prostate-specific antigen (PSA) levels following after radical prostatectomy. Led by John Nikitas and published in the latest issue of JNCCN, the study highlights PSMA PET/CT’s ability to refine treatment strategies for recurrent prostate cancer.

The challenge of prostate cancer recurrence

Prostate cancer is the second most common cancer in men, with 20–40% of patients experiencing biochemical recurrence within 10 years of radical prostatectomy. Salvage radiotherapy (sRT) to the prostate bed is the standard treatment and is recommended when prostate-specific antigen (PSA) levels are 0.1 to 0.2. However, conventional imaging modalities, such as CT and MRI, have limited sensitivity for detecting recurrent disease at low PSA levels (<1 ng/mL), often leading to generalized treatment approaches. PSMA PET/CT offers enhanced sensitivity, enabling precise targeting of PSMA-avid disease and more personalized therapy.

Key study results

This study analyzed data from 113 patients treated at the  UCLA Jonsson Comprehensive Cancer Center between 2016 and 2021. All patients underwent PSMA PET/CT scans within 3 months of undergoing sRT and had at least 24 months of follow-up. The results were striking: patients with no visible disease (T0N0M0) had the most favorable progression-free survival (PFS), with whole-pelvis radiotherapy showing no significant benefit compared to prostate bed radiotherapy alone. Whereas those with local visible disease (TrN0M0) benefited significantly from whole-pelvis radiotherapy. For patients with nodal or distant metastases (N1/M1), androgen deprivation therapy (ADT) was associated with improved PFS.

“PSMA PET/CT allows us to move beyond one-size-fits-all radiation therapy to treatment tailored to the anatomy and biology of each patient’s cancer,” explained Nikitas. “This approach not only improves outcomes but also reduces unnecessary side effects.”

Potential clinical impact

The 5-year outcomes underscore the impact of PSMA PET/CT-guided sRT. At 5 years, approximately three-quarters of patients were free from distant metastasis (72.4%), and nearly all were alive (overall survival was 97.1% at 5 years). Despite its promise, the study highlights challenges in accessibility and implementation. PSMA PET/CT scans are not yet universally available, and their integration into clinical practice requires significant resources.

“This research highlights the importance of facilitating routine PSMA PET/CT scans in patients with a biochemical recurrence of prostate cancer after surgery to remove the prostate gland,” said Nikitas. “The information from these scans is strongly associated with long-term outcomes and frequently changes treatment recommendations. We found that other measures, like PSA levels, were not strongly associated with long-term response to secondary/salvage therapy.”

Expert commentary on the treatment landscape

An accompanying commentary by Edward Christopher Dee and co-authors (all Memorial Sloan Kettering Cancer Center, NY, USA), emphasizes the transformative potential of PSMA PET/CT in prostate cancer care. “This study shows that seeing where the cancer is, even at low PSA levels, may meaningfully shape treatment decisions and could potentially influence long-term outcomes,” Dee noted. “It’s a step forward in making prostate cancer care more precise and effective.”

These findings highlight the potential of PSMA PET/CT to improve long-term outcomes for patients with recurrent prostate cancer. However, equitable access to PSMA PET/CT technology remains a critical challenge. Collaboration among healthcare providers, policymakers and researchers is essential to transition this breakthrough from clinical innovation to a sustainable standard of care, transforming outcomes for patients with recurrent prostate cancer.