Prognostic value of PSMA PET/CT-based in predicting biochemical recurrence after radical prostatectomy in miN0 patients

In this international multicenter retrospective study, we analyzed 476 patients with localized or locally advanced prostate cancer without suspicious lymph node involvement (miN0). All patients were staged with PSMA PET/CT and MRI before radical prostatectomy (2016–2023). We assessed the added value of PSMA PET/CT local staging alongside MRI in predicting biochemical recurrence free survival (BRFS). A minimum follow-up of 6 months was required. Multivariable Cox-regression showed PSA, biopsy ISUP GG, MRI T‑stage and PSMA PET T‑stage as independent predictors of BRFS. The 2‑year BRFS was 19% in patients with T3b disease on both MRI and PSMA PET, versus 58% with T3b only on MRI (p = 0.03). The study supports that PSMA PET/CT-based local staging adds prognostic value beyond MRI alone.