The prognostic significance of a negative PSMA-PET scan prior to salvage radiotherapy following radical prostatectomy.

Adebahr, Sonja; Althaus, Alexander; Scharl, Sophia; Strouthos, Iosif; Farolfi, Andrea; Serani, Francesca; Lanzafame, Helena; Trapp, Christian; Koerber, Stefan A; Peeken, Jan C; Vogel, Marco M E; Vrachimis, Alexis; Spohn, Simon K B; Grosu, Anca-Ligia; Kroeze, Stephanie G C; Guckenberger, Matthias; Fanti, Stefano; Hruby, George; Emmett, Louise; Belka, Claus; ... (2024). The prognostic significance of a negative PSMA-PET scan prior to salvage radiotherapy following radical prostatectomy. European journal of nuclear medicine and molecular imaging, 51(2), pp. 558-567. Springer 10.1007/s00259-023-06438-3

s00259-023-06438-3.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview


The optimal management for early recurrent prostate cancer following radical prostatectomy (RP) in patients with negative prostate-specific membrane antigen positron-emission tomography (PSMA-PET) scan is an ongoing subject of debate. The aim of this study was to evaluate the outcome of salvage radiotherapy (SRT) in patients with biochemical recurrence with negative PSMA PET finding.


This retrospective, multicenter (11 centers, 5 countries) analysis included patients who underwent SRT following biochemical recurrence (BR) of PC after RP without evidence of disease on PSMA-PET staging. Biochemical recurrence-free survival (bRFS), metastatic-free survival (MFS) and overall survival (OS) were assessed using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predefined predictors of survival outcomes.


Three hundred patients were included, 253 (84.3%) received SRT to the prostate bed only, 46 (15.3%) additional elective pelvic nodal irradiation, respectively. Only 41 patients (13.7%) received concomitant androgen deprivation therapy (ADT). Median follow-up after SRT was 33 months (IQR: 20-46 months). Three-year bRFS, MFS, and OS following SRT were 73.9%, 87.8%, and 99.1%, respectively. Three-year bRFS was 77.5% and 48.3% for patients with PSA levels before PSMA-PET ≤ 0.5 ng/ml and > 0.5 ng/ml, respectively. Using univariate analysis, the International Society of Urological Pathology (ISUP) grade > 2 (p = 0.006), metastatic pelvic lymph nodes at surgery (p = 0.032), seminal vesicle involvement (p < 0.001), pre-SRT PSA level of > 0.5 ng/ml (p = 0.004), and lack of concomitant ADT (p = 0.023) were significantly associated with worse bRFS. On multivariate Cox proportional hazards, seminal vesicle infiltration (p = 0.007), ISUP score >2 (p = 0.048), and pre SRT PSA level > 0.5 ng/ml (p = 0.013) remained significantly associated with worse bRFS.


Favorable bRFS after SRT in patients with BR and negative PSMA-PET following RP was achieved. These data support the usage of early SRT for patients with negative PSMA-PET findings.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine

UniBE Contributor:

Althaus, Alexander Maria Georg, Aebersold, Daniel Matthias, Afshar Oromieh, Ali, Shelan, Mohamed


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

25 Sep 2023 10:35

Last Modified:

09 Jan 2024 00:13

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

PET negative PSMA-PET Prostate cancer Salvage radiotherapy




Actions (login required)

Edit item Edit item
Provide Feedback