Advanced imaging using prostate-specific membrane antigen (PSMA) PET/CT scans is enabling more precise treatment strategies for men whose prostate cancer returns after initial surgery, according to a study published February 9, 2026, in the Journal of the National Comprehensive Cancer Network.
Researchers at the UCLA Health Jonsson Comprehensive Cancer Center found that PSMA PET/CT scans can help doctors tailor radiation and hormone therapy, potentially improving long-term outcomes and reducing unnecessary side effects for patients experiencing biochemical recurrence – a rise in prostate-specific antigen (PSA) levels – following radical prostatectomy. Approximately 20 to 40 percent of men who undergo surgery for localized prostate cancer will see the cancer return within 10 years, the study noted.
The retrospective study analyzed data from 113 patients treated at UCLA between 2016 and 2021. All patients underwent PSMA PET/CT scans within three months of starting salvage radiotherapy (sRT) and were followed for at least 24 months. The results demonstrated a clear correlation between scan findings and treatment response.
Patients with no visible disease on the PSMA PET/CT scan (classified as T0N0M0) experienced the most favorable progression-free survival, and did not benefit from whole-pelvis radiotherapy compared to radiation focused on the prostate bed alone. Conversely, patients with locally visible disease (TrN0M0) showed significant improvement in progression-free survival when treated with whole-pelvis radiotherapy. For patients with cancer that had spread to lymph nodes or distant sites (N1/M1), androgen deprivation therapy (ADT) was associated with improved progression-free survival.
“PSMA PET/CT allows us to move beyond one-size-fits-all radiation therapy to treatment tailored to the anatomy and biology of each patient’s cancer,” explained John Nikitas, MD, lead author of the study and a resident at UCLA. “This approach not only improves outcomes but also reduces unnecessary side effects.”
Traditional imaging methods, such as bone scans, CT scans, and MRI, often struggle to detect recurrent prostate cancer at low PSA levels, leading doctors to treat standard areas or add hormone therapy even when it may not be necessary. PSMA PET/CT utilizes a radioactive tracer that binds to prostate-specific membrane antigen, a protein found on most prostate cancer cells, allowing for the detection of particularly small clusters of cancer that would otherwise be invisible.
At five years, approximately 72.4 percent of patients in the study were free from distant metastasis, and overall survival was 97.1 percent. The research also indicated that PSA levels alone were not strongly associated with long-term response to salvage therapy, reinforcing the importance of imaging-based treatment decisions.
An accompanying commentary in the Journal of the National Comprehensive Cancer Network, authored by Edward Christopher Dee and colleagues from Memorial Sloan Kettering Cancer Center, highlighted the transformative potential of PSMA PET/CT in prostate cancer care. Dee noted that identifying the location of cancer, even at low PSA levels, can meaningfully shape treatment decisions and potentially influence long-term outcomes.
Nikitas emphasized the demand to facilitate routine PSMA PET/CT scans for patients with biochemical recurrence after prostatectomy, stating that the information from these scans is strongly associated with long-term outcomes and frequently alters treatment recommendations. Several prospective trials, including PSMA-SRT, PEACE-V STORM, ADOPT, and PSICHE, are underway to further refine clinical practice.
