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

@article{vorbach2026psma,
  title = {{PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis}},
  author = {Samuel M. Vorbach and Thomas Seppi and Giulia Santo and Irene Virgolini and Ute Ganswindt and Michael Keilholz and Sarah Frederike Brose and Jozefina Casuscelli and Konrad Klimek and Rudolf A. Werner and Nina-Sophie Schmidt-Hegemann and Claus Belka and Christian Trapp and Paul Rogowski},
  journal = {European Journal of Nuclear Medicine and Molecular Imaging},
  year = {2026},
  month = sep,
  doi = {10.1007/s00259-026-08147-z},
  url = {https://doi.org/10.1007/s00259-026-08147-z},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis
AU  - Samuel M. Vorbach
AU  - Thomas Seppi
AU  - Giulia Santo
AU  - Irene Virgolini
AU  - Ute Ganswindt
AU  - Michael Keilholz
AU  - Sarah Frederike Brose
AU  - Jozefina Casuscelli
AU  - Konrad Klimek
AU  - Rudolf A. Werner
AU  - Nina-Sophie Schmidt-Hegemann
AU  - Claus Belka
AU  - Christian Trapp
AU  - Paul Rogowski
PY  - 2026
DA  - 2026/09/04
JO  - European Journal of Nuclear Medicine and Molecular Imaging
DO  - 10.1007/s00259-026-08147-z
UR  - https://doi.org/10.1007/s00259-026-08147-z
AB  - 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08147-z.
SN  - 1619-7070
SN  - 1619-7089
ER  -