New research published by Nikitas et al in JNCCN—Journal of the National Comprehensive Cancer Network found that incorporating information from prostate-specific membrane antigen (PSMA) positron-emission tomography/computed tomography (PET/CT) scans may be able to predict progression-free survival and guide treatment planning in patients with rising prostate-specific antigen (PSA) levels following removal of the prostate.
The researchers used retrospective clinical data from 113 patients treated for prostate cancer at the University of California Los Angeles (UCLA) Jonsson Comprehensive Cancer Center. All were staged with PSMA PET/CT scans for recurrent disease.
According to exploratory analysis, patients who showed no visible disease on the scans (T0N0M0) had the most favorable progression-free survival, and whole-pelvis radiotherapy (WPRT) provided no significant benefit compared to prostate bed radiotherapy alone in this patient group. However, WPRT did significantly improve progression-free survival for patients with local, visible disease (TrN0M0). For patients with nodal or distant metastatic disease visible on the scans, receipt of androgen-deprivation therapy was significantly associated with improved progression-free survival. Thus, PSMA PET/CT scans may help better tailor therapy to avoid disease recurrence in this patient population.
“This research highlights the importance of facilitating routine PSMA PET/CT scans in patients with a biochemical recurrence of prostate cancer after surgery to remove the prostate gland,” said lead author John Nikitas, MD, of the UCLA Jonsson Comprehensive Cancer Center. “The information from these scans is strongly associated with long-term outcomes and frequently changes treatment recommendations. We found that other measures, like PSA levels, were not strongly associated with long-term response to secondary/salvage therapy.”
The researchers noted that by using PET/CT scans, they may be able to tailor therapies to not only achieve better results but also to reduce side effects by avoiding any treatments that are less likely to be effective.
“PSMA PET/CT imaging lets us move from one-size-fits-all radiation therapy in the secondary/salvage setting to treatment that’s guided by the anatomy, and perhaps by extension, the actual biology of a patient’s prostate cancer,” commented E. Christopher Dee, MD, of Memorial Sloan Kettering Cancer Center, who was not involved in this research. “This study shows that seeing where the cancer is, even at low PSA levels, may meaningfully shape treatment decisions and could potentially influence long-term outcomes. It’s a step forward in making prostate cancer care more precise and effective and can inform future prospective research in the secondary/salvage radiation space.”
Dr. Dee co-authored a longer commentary on the study that is also featured in the February 2026 issue of JNCCN.
DISCLOSURE: For full disclosures of the study authors, visit jnccn.org.
