European Journal of Nuclear Medicine and Molecular Imaging最新文献

{"title":"Baseline serum carcinoembryonic antigen (CEA) is an independent prognostic biomarker for metastatic castration-resistant prostate cancer (mCRPC) patients receiving 177Lu-PSMA therapy","authors":"Emilio Francesco Giunta,Irene Marini,Ilaria Grassi,Silvia Nicolini,Flavia Foca,Monica Celli,Paola Caroli,Anna Sarnelli,Nicole Brighi,Giuseppe Schepisi,Manuela Monti,Ugo De Giorgi,Cristian Lolli,Maddalena Sansovini","doi":"10.1007/s00259-026-08173-x","DOIUrl":"https://doi.org/10.1007/s00259-026-08173-x","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"22 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APOE4-dependent cholinergic/dopaminergic contributions to clinical symptoms across Alzheimer's disease spectrum: A retrospective observational study.","authors":"Sungwoo Kang, Seun Jeon, Donggeon Lee, Hanbi Lee, Su-Hee Jeon, Minsun Choi, Young-Gun Lee, Na-Young Shin, Mijin Yun, Byoung Seok Ye","doi":"10.1007/s00259-026-08165-x","DOIUrl":"https://doi.org/10.1007/s00259-026-08165-x","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical heterogeneity in Alzheimer's disease (AD) may reflect differential involvement of neurotransmitter systems, but whether the associations of cholinergic and dopaminergic imaging biomarkers with cognitive and neuropsychiatric symptoms differ according to apolipoprotein E ε4 (APOE4) status remains unclear.</p><p><strong>Methods: </strong>We studied 387 patients across the amyloid-confirmed AD spectrum. Patients were stratified by APOE4 status into 205 carriers and 182 non-carriers. Basal forebrain volume (BFV), striatal dopamine transporter uptake (DAT), and regional brain perfusion were examined in relation to cognitive performance and neuropsychiatric inventory scores.</p><p><strong>Results: </strong>APOE4 carriers showed lower BFV than non-carriers, whereas APOE4 non-carriers showed lower DAT. In APOE4 carriers, lower BFV was associated with memory dysfunction and AD-typical temporoparietal hypoperfusion; the BFV-memory association was attenuated after inclusion of posterior cingulate perfusion. Lower BFV was also associated with several neuropsychiatric symptoms, including hallucinations, delusions, anxiety, apathy, aberrant motor behavior, and appetite changes, with direct associations remaining for hallucinations, delusions, and apathy after accounting for regional perfusion. In APOE4 non-carriers, lower DAT was associated with poorer performance across widespread cognitive domains and with hallucinations, delusions, and anxiety. These DAT associations largely persisted even after adjustment for regional perfusion.</p><p><strong>Conclusion: </strong>APOE4 status was associated with differences in the clinical and brain perfusion correlates of cholinergic and dopaminergic degeneration in AD. APOE4 carriers showed a BFV-dominant pattern linked to AD-typical perfusion changes and memory dysfunction, whereas non-carriers showed a DAT-dominant pattern with largely perfusion-independent associations with cognitive and neuropsychiatric manifestations.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient selection for primary staging with [99mTc]Tc-PSMA SPECT/CT: influence of combined PSA and ISUP grade on detection of metastatic disease.","authors":"Knut Liepe, Tony Matti Hoang, Isabell Dietrich, Hans-Jürgen Piechota, Marcel Baehr","doi":"10.1007/s00259-026-08168-8","DOIUrl":"https://doi.org/10.1007/s00259-026-08168-8","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to examine the combined influence of initial PSA level (iPSA) and ISUP grade on the detection rates of [99mTc]Tc-PSMA SPECT/CT in patients undergoing primary staging of prostate cancer and to identify selection criteria.</p><p><strong>Patients and methods: </strong>In this retrospective study, 91 patients underwent SPECT/CT following administration of 670 MBq (range, 470-792 MBq) [99mTc]Tc-MIP-1404. Detection rates of the primary tumour, pelvic lymph node metastases and distant metastases were determined together with imaging biomarkers. Univariate and multivariate nominal logistic regression analyses identified predictors of metastatic disease.</p><p><strong>Results: </strong>Both iPSA level and ISUP grade were independent predictors of metastatic disease (p_PSA=0.0004, p_ISUP=0.0015). SUVmax correlated strongly with ISUP grade (r = 0.61) but was not a reliable surrogate marker. Detection rates ≥ 50% were observed at ISUP grades 1-3 with iPSA > 50 ng/ml and at ISUP grades 4-5 with iPSA > 20 ng/ml. Metastases were detected in all patients with iPSA > 50 ng/ml, regardless of ISUP grade. Pelvic lymph node metastases predominated at ISUP grades 1-3 across all iPSA and at ISUP grades 4-5 with iPSA ≤ 20ng/ml. Conversely, distant metastases were more frequent at ISUP grades 4-5 with initial PSA > 50ng/ml.</p><p><strong>Conclusion: </strong>Patient selection for [99mTc]Tc-PSMA SPECT/CT may be improved by incorporating ISUP grade and iPSA, particularly ISUP grades 4-5 with iPSA > 20 ng/ml and ISUP grades 1-3 with iPSA > 50 ng/ml. Distinct patterns of metastatic spread were observed according to both ISUP grade and iPSA. Where PSMA PET/CT is unavailable, [99mTc]Tc-PSMA SPECT/CT may represent a valuable alternative for primary staging of selected patients with PCa.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ and tumor dosimetry of [¹⁶¹Tb]Tb-PSMA-617 radioligand therapy in patients with mCRPC.","authors":"Andrea Schaefer-Schuler, Arne Blickle, Sebastian Ganz, Sven Petto, Caroline Burgard, Tilman Speicher, Moritz B Bastian, Stephan Maus, Mark Bartholomä, Samer Ezziddin, Florian Rosar","doi":"10.1007/s00259-026-08171-z","DOIUrl":"https://doi.org/10.1007/s00259-026-08171-z","url":null,"abstract":"<p><strong>Purpose: </strong>Terbium-161 (¹⁶¹Tb) has emerged as a promising radionuclide for radioligand therapy (RLT) due to its emission of Auger and conversion electrons, which may support therapeutic efficacy through increased local energy deposition. Despite growing research efforts aimed at the clinical potential of ¹⁶¹Tb, dosimetric data, particularly for tumor lesions, remain scarce. To address this gap, we assessed tumor and organ dosimetry in mCRPC patients treated with [¹⁶¹Tb]Tb-PSMA-617.</p><p><strong>Methods: </strong>The study involved n = 15 patients with metastasized castration-resistant prostate cancer (mCRPC) participating in a registry (NCT04833517) and receiving [¹⁶¹Tb]Tb-PSMA-617. All patients received a median of 2 (range: 1-3) cycles with mean administered activity of 6.0 ± 1.3 GBq and mean cumulative activity of 12.3 ± 4.6 GBq [¹⁶¹Tb]Tb-PSMA-617. Hybrid dosimetry of organs at risk, including the salivary glands, the kidneys, the liver, and tumor lesions was performed analyzing whole-body planar and SPECT/CT images. Absorbed doses were estimated using OLINDA/EXM for ¹⁶¹Tb. Tumor-to-organ ratios (TR) of mean tumor-absorbed doses over relevant organs at risk were calculated.</p><p><strong>Results: </strong>Mean absorbed dose to kidneys, parotid glands, submandibular glands and liver was 0.70 ± 0.41 Gy/GBq, 0.40 ± 0.20 Gy/GBq, 0.36 ± 0.14 Gy/GBq and 0.13 ± 0.08 Gy/GBq, respectively. Tumor kinetics in 43 lesions demonstrated stable activity over time (mean half-life of all lesions: 44.07 h ± 15.88 h) delivering a mean overall absorbed tumor dose of 5.95 ± 3.60 Gy/GBq, the resulting TR over kidney and parotid gland were 10.55 ± 8.32 and 16.15 ± 11.85, respectively.</p><p><strong>Conclusion: </strong>[¹⁶¹Tb]Tb-PSMA-617 delivers high tumor-absorbed doses with tolerable doses to relevant organs at risk, translating into favorable tumor-to-normal-organ ratios. Dosimetry results confirm ¹⁶¹Tb as a promising radionuclide for PSMA-targeted radioligand therapy in mCRPC.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the bellmunt risk score for survival prediction in mCRPC patients undergoing [¹⁷⁷Lu]Lu-PSMA-617 therapy.","authors":"Thomas Büttner, Mike Wenzel, Philipp Mandel, Paul Schmitt, Christian Hoffmann, Milka Marinova, Markus Essler, Felix K H Chun, Manuel Ritter, Daniel Groener, Philipp Krausewitz","doi":"10.1007/s00259-026-08169-7","DOIUrl":"https://doi.org/10.1007/s00259-026-08169-7","url":null,"abstract":"<p><strong>Purpose: </strong>[¹⁷⁷Lu]Lu-PSMA-617 is a standard-of-care therapy for metastatic castration-resistant prostate cancer (mCRPC). Given the heterogeneous clinical responses, accessible prognostic tools are needed. We recently demonstrated that the Bellmunt Risk Score (BRS)-comprising ECOG performance status >0, hemoglobin <10 g/dL, and the presence of liver metastases-predicts overall survival (OS) in a primary mCRPC cohort. This study aims to externally validate the BRS in an independent cohort.</p><p><strong>Methods: </strong>We retrospectively evaluated 243 mCRPC patients treated with [¹⁷⁷Lu]Lu-PSMA-617 at an independent tertiary center. The BRS was calculated at baseline (range 0-3). Endpoints included OS analyzed via Kaplan-Meier estimators, multivariable Cox regression, Harrell's C-index, and time-dependent area under the curve (tAUC).</p><p><strong>Results: </strong>The cohort was distributed into BRS 0 (17.6%), BRS 1 (52.7%), BRS 2 (26.1%), and BRS 3 (2.9%). Kaplan-Meier analysis revealed significant risk stratification, with an estimated median OS of 24.0, 15.8, 11.2, and 8.7 months for BRS 0, 1, 2, and 3, respectively (p < 0.001). In univariable analysis, BRS significantly predicted survival. In multivariable Cox regression adjusted for the number of prior treatment lines, BRS 2 (HR 3.04, p < 0.001) and BRS 3 (HR 4.76, p = 0.002) remained independent predictors of shortened OS. The BRS demonstrated robust predictive accuracy, achieving a tAUC of 71.3% for 1-year OS.</p><p><strong>Conclusion: </strong>The BRS is a pragmatic, robust, and easily calculable prognostic tool for mCRPC patients undergoing [¹⁷⁷Lu]Lu-PSMA-617 therapy, successfully validated in an independent external cohort.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biodistribution and radiation dosimetry of the PDGFRβ targeting PET tracer [⁶⁸Ga]Ga-ATH001.","authors":"Mark Lubberink, Talakad G Lohith, Zoltan Derdak, Paul Wilkens, Emilia Palmér, Alexandra Ramolli, Mélodie Ferrat, Thuy A Tran, Bogdan Mitran, Ayman Abouyzayed, Lars Johansson, Haakan Wennbo, Fredrik Rorsman, Johan Vessby, Olof Eriksson","doi":"10.1007/s00259-026-08167-9","DOIUrl":"https://doi.org/10.1007/s00259-026-08167-9","url":null,"abstract":"<p><strong>Purpose: </strong>[⁶⁸Ga]Ga-ATH001 is an Affibody molecule targeting PDGFRβ in development as a Positron Emission Tomography (PET) tracer for non-invasive imaging of active fibrosis. Here we present first-in-human [⁶⁸Ga]Ga-ATH001 biodistribution and radiation dosimetry data.</p><p><strong>Methods: </strong>Radiation dosimetry of [⁶⁸Ga]Ga-ATH001 was evaluated in healthy participants (n = 3) and participants with metabolic dysfunction-associated steatohepatitis (MASH) (n = 3). Each participant was intravenously administered ~ 2.5 MBq/kg [⁶⁸Ga]Ga-ATH001 and imaged by whole-body PET for up to 3 h post-injection. Absorbed dose coefficients and effective doses according to ICRP 103 were calculated using IDAC DOSE 2.1.</p><p><strong>Results: </strong>The effective dose of [⁶⁸Ga]Ga-ATH001 was 0.028 ± 0.002 mSv/MBq with kidneys as the dose-limiting organ. Administration of a target dose of 2 MBq/kg would result in a sex-averaged effective dose of 4.1 mSv. Subjects tolerated the tracer administration well.</p><p><strong>Conclusion: </strong>[⁶⁸Ga]Ga-ATH001 demonstrates a dosimetry and safety profile that supports further clinical development as a repeatable, non-invasive PET marker of active fibrosis in tissue.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[⁶⁸Ga]Ga-CTR-FAPI versus [⁶⁸Ga]Ga-FAPI-04 PET/CT for patient evaluation in radioiodine-refractory differentiated thyroid cancer: A prospective comparative study","authors":"Shengyan Liu,Xin Zhang,Ruochen Li,Ziren Kong,Xi-yang Cui,Zhu Li,Cong Shi,Dongxiao Bian,Yihan Zhao,Qijun Li,Yijin Pan,Zhaohui Zhu,Zhibo Liu,Shaoyan Liu,Yansong Lin","doi":"10.1007/s00259-026-08150-4","DOIUrl":"https://doi.org/10.1007/s00259-026-08150-4","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"176 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of bone metastases on [18F]NaF PET/CT in 734 patients with newly diagnosed prostate cancer","authors":"Claus Madsen,Helle D. Zacho,Rasmus Bisbjerg,Dan Fuglø,Peter B. Østergren","doi":"10.1007/s00259-026-08148-y","DOIUrl":"https://doi.org/10.1007/s00259-026-08148-y","url":null,"abstract":"Abstract Purpose International guidelines recommend assessment for bone metastases in patients with high-risk prostate cancer (PC) and those with unfavourable intermediate-risk disease. These recommendations are largely based on studies using planar bone scintigraphy. We aimed to assess the diagnostic accuracy of [ 18 F]sodium fluoride ([ 18 F]NaF) PET/CT in newly diagnosed PC. We also evaluated the clinical utility of routine bone imaging in patients with unfavourable intermediate-risk disease and International Society of Urological Pathology grade group (ISUP GG) 3. Methods This retrospective single-center study included 734 consecutive patients with newly diagnosed PC who underwent [ 18 F]NaF PET/CT for primary staging. Patients were classified according to the current European Association of Urology risk classification, with the intermediate-risk subgroup restricted to patients with ISUP GG 3. All scan reports were retrospectively reviewed, and patient-level findings regarding bone metastases were validated against a reference standard based on follow-up imaging and clinical data. Sensitivity, specificity, and predictive values were calculated. Results Of the 734 patients, 607 (83%) had high-risk disease and 127 (17%) had intermediate-risk disease with ISUP GG 3. Overall, bone metastases were detected in 225 patients (31%). Among high-risk patients, 224 (37%) had bone metastases, whereas only 1 of 127 intermediate-risk patients (0.8%) had bone metastases on [ 18 F]NaF PET/CT. Follow-up identified one additional potential false-negative case in the intermediate-risk group. Among patients with a conclusive reference standard ( n  = 689), sensitivity and specificity were 0.90 and 0.99, respectively. Conclusion [ 18 F]NaF PET/CT demonstrates high diagnostic accuracy for the detection of bone metastases in newly diagnosed PC. However, given the very low prevalence of bone metastases, its clinical utility in patients with unfavourable intermediate-risk disease and ISUP GG 3 appears limited.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"59 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148895940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed total-body [18F]FDG PET/CT demonstrates systemic vascular inflammation after concurrent chemoradiotherapy in patients with head and neck cancer","authors":"Guobing Liu,Yasser G. Abdelhafez,Brahim Mehadji,Martina Di Franco,Benjamin A. Spencer,Siqi Li,Fatma Sen,Jinger Yu Sun,Shyam Rao,Abass Alavi,Hongcheng Shi,Guobao Wang,Lorenzo Nardo","doi":"10.1007/s00259-026-08160-2","DOIUrl":"https://doi.org/10.1007/s00259-026-08160-2","url":null,"abstract":"","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"27 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSMA PET/CT-guided salvage elective nodal radiotherapy for nodal metastases after radical prostatectomy: a bi-institutional long-term outcome analysis","authors":"Samuel M. Vorbach, Thomas Seppi, Giulia Santo, Irene Virgolini, Ute Ganswindt, Michael Keilholz, Sarah Frederike Brose, Jozefina Casuscelli, Konrad Klimek, Rudolf A. Werner, Nina-Sophie Schmidt-Hegemann, Claus Belka, Christian Trapp, Paul Rogowski","doi":"10.1007/s00259-026-08147-z","DOIUrl":"https://doi.org/10.1007/s00259-026-08147-z","url":null,"abstract":"Purpose PSMA PET/CT has transformed the detection of nodal recurrence after radical prostatectomy, yet real-world evidence on long-term outcomes of PSMA PET/CT-guided salvage elective nodal radiotherapy (ENRT) remains limited. This study evaluated oncological outcomes of PSMA PET/CT-guided salvage ENRT in a bi-institutional cohort with extended follow-up. Methods We retrospectively analysed 179 patients who received PSMA PET/CT-based ENRT for nodal recurrence after radical prostatectomy at two tertiary centres between 2014 and 2024. Patients with pelvic and/or paraaortic lymph node metastases were included. The primary endpoint was metastasis-free survival (MFS); secondary endpoints included biochemical progression-free survival (BPFS) and overall survival (OS). Survival outcomes were estimated using the Kaplan–Meier method, and prognostic factors were assessed using Cox regression analysis. Results Of the 179 patients, 104 (58.1%) had true biochemical recurrence after radical prostatectomy, whereas 75 (41.9%) had PSA persistence. After a median follow-up of 60.3 months, 5-year MFS and BPFS rates were 74.3% and 62.3%, respectively, in patients with true biochemical recurrence, compared with 61.2% and 56.4% in the overall cohort. In multivariable analyses of the entire cohort, concomitant ADT was associated with improved MFS (HR 0.36, <jats:italic>p</jats:italic> &lt; 0.001) and BPFS (HR 0.26, <jats:italic>p</jats:italic> &lt; 0.001), compared with no ADT. PSA persistence after surgery was associated with worse outcomes (MFS: HR 2.72, <jats:italic>p</jats:italic> &lt; 0.001; BPFS: HR 2.09, <jats:italic>p</jats:italic> = 0.005). Conclusion PSMA PET/CT-guided salvage ENRT predominantly combined with ADT provides durable long-term disease control in patients with nodal recurrence in routine clinical practice. In patients with true recurrence after radical prostatectomy, the 5-year MFS rate was 74.3%, approaching outcomes reported in prospective trials. However, the absence of systematically collected clinician-assessed toxicity and patient-reported outcomes precludes a reliable assessment of treatment tolerability.","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":"5 1","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148884000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}