PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a…

Cohort studyEuropean journal of nuclear medicine and molecular imaging· Sep 2026

PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis.

Samuel M Vorbach, Thomas Seppi, Giulia Santo … Paul Rogowski

TheranosticsCohort studyQ1IF 5.8

With true recurrence, salvage nodal radiotherapy gave 74.3% 5-year metastasis-free survival

PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis.

Samuel M Vorbach … Paul Rogowski

European journal of nuclear medicine and molecular imaging · Sep 2026 · Q1 in Radiology

Background

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 (elective nodal radiotherapy) remains limited.

Purpose

This study evaluated oncological outcomes of PSMA PET/CT-guided salvage elective nodal radiotherapy in a bi-institutional cohort with extended follow-up.

Methods

We retrospectively analysed 179 patients who received PSMA PET/CT-based elective nodal radiotherapy for nodal recurrence after radical prostatectomy at two tertiary centres between 2014 and 2024.

n = 179 patients

Results

with true recurrence, most patients stayed metastasis-free at 5 years

74.3%

True recurrence 5-yr M

61.2%

Overall cohort 5-yr MF

More results

Of the 179 patients, 104 (58.1%) had true biochemical recurrence after radical prostatectomy, whereas 75 (41.9%) had PSA persistence.

In multivariable analyses of the entire cohort, concomitant ADT was associated with improved metastasis-free survival (HR 0.36, p < 0.001) and biochemical progression-free survival (HR 0.26, p < 0.001), compared with no ADT.

More results

PSA persistence after surgery was associated with worse outcomes (metastasis-free survival: HR 2.72, p < 0.001; biochemical progression-free survival: HR 2.09, p = 0.005).

“

Conclusion · 1 of 3

PSMA PET/CT-guided salvage elective nodal radiotherapy predominantly combined with ADT provides durable long-term disease control in patients with nodal recurrence in routine clinical practice.

Conclusion · 2 of 3

In patients with true recurrence after radical prostatectomy, the 5-year metastasis-free survival rate was 74.3%, approaching outcomes reported in prospective trials.

Conclusion · 3 of 3

However, the absence of systematically collected clinician-assessed toxicity and patient-reported outcomes precludes a reliable assessment of treatment tolerability.

PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis.

PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis.

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