Related Experiment Video
Updated: Mar 25, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
PET/CT and MRI directed extended salvage radiotherapy in recurrent prostate cancer with lymph node metastases
Hans Christian Rischke1, Ann-Kristin Eiberger2, Natalja Volegova-Neher2
1Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany; Department of Nuclear Medicine, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
Purpose:
PET/CT directed extended salvage radiotherapy (esRT) of involved lymph-node (LN) regions may be a salvage strategy for patients with nodal recurrent prostate cancer (PCa) after primary therapy or after previous prostate fossa salvage RT. The aim of the study was to determine the time until prostate-specific antigen (PSA) progression, pattern of failure and toxicity after esRT.
Material And Methods:
25 patients with nodal or nodal+local recurrent PCa confirmed by Choline-PET/CT and Magnetic Resonance Imaging (MRI) were treated with esRT at the sites of recurrence. Acute and late toxicity was recorded. In case of subsequent PSA progression, imaging was performed to confirm next relapse. Mean follow-up was 2.9 years.
Results:
According to Choline-PET/CT and MRI findings, 84% (21/25) of esRT were treatment of pelvic only, 12% (3/25) of retroperitoneal only and 4% (1/25) of both pelvic and retroperitoneal regions. 40% (10/25) received concomitant irradiation of the prostatic fossa (after primary radical prostatectomy). Median time to PSA progression of the whole cohort was 19.6 months. Median time to PSA progression for patients with 1-2 PET-positive LN (n=15) was 34.9 months versus median 12.7 months for patients with PET-positive LN≥3 (n=10), p-value: 0.0476. Acute and late toxicity was mild to moderate, no grade-3 adverse events were observed.
Conclusion:
PET/CT and MRI directed esRT of nodal recurrent PCa with or without local recurrence is feasible with low acute and late toxicity. Patients with only one or two PET-positive LN treated by esRT achieved prolonged complete biochemical remission.
