To discuss the implications of PSMA-PET-guided salvage radiotherapy (PSMAiSRT) in prostate cancer treatment, focusing on timing versus precision.
Key Findings:
PSMAiSRT prolongs failure-free survival without excess toxicity, particularly at PSA levels of 0.3 ng/mL or greater.
Early SRT is recommended at PSA levels of 0.1 to 0.2 ng/mL to maximize metastasis-free survival.
PSMA-PET may improve localization of disease but does not necessarily indicate actionable disease.
Interpretation:
PSMA-PET should enhance the delivery of salvage RT rather than dictate the timing of its initiation, emphasizing the need for an early-and-precise approach.
Limitations:
The trial's limited size and focus on failure-free survival restrict conclusions on overall survival.
Baseline heterogeneity in elective pelvic RT coverage complicates interpretation of results.
Conclusion:
An early-and-precise approach to SRT, informed by PSMA-PET, is recommended until further evidence from ongoing trials is available.
