Salvage radiotherapy (sRT) is recommended as a curative treatment for men experiencing biochemical recurrence of prostate cancer following radical prostatectomy. Prostate-specific membrane antigen (PSMA) PET/CT scans have shown high sensitivity in detecting recurrent disease even at low prostate-specific antigen (PSA) levels, potentially improving treatment decisions. Despite this, limited research has examined how pre-sRT PSMA PET/CT impacts patient outcomes such as recurrence-free and overall survival, and no direct comparison exists between patients who did or did not undergo PSMA PET/CT before sRT. A recent study addressed this gap by analysing real-world data from Danish clinical practice, revealing a notable survival benefit linked to PSMA PET/CT use.
The study evaluated 844 patients treated with sRT in Denmark from 2015 to 2023, all with PSA levels between 0.2 and 1.0 ng/mL at treatment initiation. Patients were divided into two groups based on whether they received a PSMA PET/CT scan before sRT. Overall survival up to 5 years post-sRT was the primary outcome, while biochemical recurrence-free survival (BRFS) was examined as a secondary outcome. The data were collected routinely in clinical practice, reflecting real-world treatment patterns and outcomes.
Results showed that 308 patients (36.5%) underwent PSMA PET/CT before sRT. Those patients experienced significantly higher overall survival rates at 1, 2, and 5 years (100%, 99.5%, and 98.1%, respectively) compared with 99%, 97.8%, and 93.8% in patients without pre-sRT PSMA PET/CT. The crude hazard ratio (HR) for mortality was 3.31 favouring the PSMA PET/CT group (p=0.0486). Similarly, the 3-year BRFS rates were 74.9% for the PSMA PET/CT group and 69.4% for those without (HR: 1.53; p=0.0187), aligning with overall survival trends.
These findings suggest that PSMA PET/CT before sRT is associated with improved survival outcomes and better biochemical control. The study’s real-world design strengthens the clinical relevance, though limitations include its observational nature and potential selection biases. Despite these, incorporating PSMA PET/CT into routine pre-sRT evaluation may enhance personalised treatment planning and patient prognosis. Further randomised trials are warranted to confirm these results and refine clinical guidelines.
Reference
Mogensen AW et al. The Use of PSMA PET/CT Improves Overall Survival in Men with Biochemically Recurrent Prostate Cancer Treated with Salvage Radiotherapy: Real-World Data from an Entire Country. J Nucl Med. 2025;DOI: 10.2967/jnumed.125.269996.
