Objective:

To analyze biochemical recurrence-free survival (BRFS) and distant metastasis-free survival (DMFS) in patients treated with PSMA-PET/CT-based salvage elective nodal radiotherapy (sENRT) after radical prostatectomy (RP) and to identify predictive markers for optimized patient selection, which may enhance treatment personalization.

Key Findings:

• The median follow-up after sENRT was 32.6 months, indicating the need for long-term monitoring.
• 63.2% of patients had an initial tumor stage of ≥ pT3, suggesting a high-risk cohort.
• 72.4% of patients had an ISUP score of 3 or higher, correlating with aggressive disease.
• 79% of patients had an initial negative nodal stage (pN0), highlighting the potential for early intervention.
• 27.6% had positive surgical margins (R1), which may influence recurrence rates.

Interpretation:

The study suggests that PSMA-PET/CT-based sENRT may improve BRFS and DMFS in patients with nodal recurrence after RP, with potential implications for treatment personalization, particularly in selecting patients based on tumor characteristics.

Limitations:

• Retrospective design may introduce selection bias, affecting the reliability of results.
• Limited sample size may affect generalizability of results, necessitating larger studies.
• Lack of randomization in the study design limits the strength of conclusions drawn.

Conclusion:

PSMA-PET/CT-based sENRT appears to be a promising approach for managing lymph node recurrence in prostate cancer, warranting further investigation and standardization in treatment protocols, particularly in identifying optimal patient selection criteria.