A two-centre phase 2 randomised trial assigned 253 men planned for standard radiotherapy to standard of care or to radiotherapy intensified to every site detected on PSMA-PET, across salvage post-prostatectomy, high-risk, oligometastatic and post-radiotherapy strata. At a median 66 months, five-year failure-free survival was 66% with PSMA-guided treatment versus 62% with standard care (HR 0.80), short of the prespecified threshold; freedom from biochemical progression was 72% versus 65% (sHR 0.70). Estimates favoured PSMA-guided treatment more in the high-risk and post-prostatectomy strata, where the combined analysis was post hoc, and one grade 3 or worse event was possibly related to dose escalation.
Why it is interesting: Randomised outcome data on whether treatment guided by PSMA-PET lesion detection improves outcomes, ahead of the phase 3 PATRON trial.