PSMA-guided salvage surgery in 30 patients: PSA fell in 93%, but 83% had biochemical progression

Robot-assisted PSMA-radioguided salvage surgery produced an early PSA decline in 28 of 30 patients with recurrent prostate cancer, but 25 of them later developed biochemical progression, according to endocrinologyadvisor.com. The post hoc analysis of the prospective TRACE-I trial (NCT03857113) was published online on August 29, 2026 in European Urology Focus by Lotte G. Zuur of the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, and colleagues. renalandurologynews.comendocrinologyadvisor.comrenalandurologynews.comOpen source ↗

Cohort and surgical results

The analysis included 30 patients with biochemical recurrence after radical prostatectomy, radiation therapy, or both. All had fewer than 3 pelvic recurrences on PSMA PET/CT. Median age was 68 years, and median PSA at surgery was 1.02 ng/mL (IQR, 0.46-2.86). Previous treatment was radical prostatectomy in 19 patients, radiotherapy in 9, and both in 2. The median interval between the last treatment and salvage surgery was 62 months (IQR, 37-112).

With a technetium-99m-labeled PSMA tracer and a DROP-IN gamma probe, investigators identified 32 of 34 PSMA-avid lesions (94%). Resection was successful in 29 patients (97%), and histopathology revealed additional lesions in 7 (23%).

Postoperative complications occurred in 10 patients (33%), mostly Clavien-Dindo grade 1 (n=9). One patient (3%) had a grade 3b ureteral injury requiring reimplantation. No grade 4 or 5 complications occurred. renalandurologynews.comendocrinologyadvisor.comrenalandurologynews.comOpen source ↗

PSA response and progression

At the first PSA assessment, within 6-12 weeks of surgery, 28 patients (93%) had a PSA decline. In 20 (66%), PSA fell below 0.2 ng/mL after radical prostatectomy or reached the nadir after radiotherapy.

However, 25 patients (83%) developed biochemical progression over a median follow-up of 39 months (IQR, 33-45). Median time to progression was 7.5 months (95% CI, 1-31). Biochemical progression-free survival was 40% at 12 months and 30% at 24 months. At 24 months, distant metastasis-free survival was 62% and subsequent therapy-free survival was 58%.

Follow-up PSMA PET/CT found recurrence in 23 patients (77%): in pelvic lymph nodes in 11 (37%), extrapelvic nodes in 6 (20%), and bone in 5 (17%). A longer interval between previous treatment and surgery was associated with higher risk of biochemical progression (hazard ratio, 1.13; 95% CI, 1.03-1.23; P=.007). renalandurologynews.comendocrinologyadvisor.comrenalandurologynews.comOpen source ↗

The cohort was small, from a single center, and had no control group. The authors write that the surgery is associated with a period of biochemical progression-free survival and a delayed need for additional therapy, with a subset of patients remaining disease free, and that further prospective comparative research is needed.