Salvage Radiotherapy Confers an Overall Survival Advantage in Biochemical Recurrence of Prostate Cancer: Evidence from the International PROMISE Registry

The impact of salvage radiotherapy (SRT) on overall survival (OS) in patients experiencing biochemical recurrence (BCR) of prostate cancer remains an area of active investigation. The international multicenter PROMISE registry provides a valuable dataset to explore the association between SRT and long-term clinical outcomes in this patient population (NCT06320223). <b>Methods:</b> Comprehensive restaging at the time of BCR was performed by integrating both serologic markers and advanced molecular imaging (PET/CT or PET/MRI), offering an accurate assessment of molecular imaging (mi) TNM stage. <b>Results:</b> In total, 1410 patients experiencing BCR with prior prostatectomy were included. The median follow-up was 5.2 y (interquartile range, 3.8–6.9 y). SRT was administered after PET to 381 of 680 patients (56.0%) with PET-negative disease (miT0N0M0) and to 478 of 730 patients (65.0%) with PET-locoregional disease (miT/N+ M0). SRT was associated with longer OS in the entire cohort (hazard ratio, 0.66; 95% CI, 0.47–0.93; <i>P</i> = 0.019) with 5- and 7-y survival rates of 95.2% (95% CI, 93.6%–96.8%) and 90.8% (95% CI, 88.1%–93.6%), respectively. Without SRT, 5- and 7-y survival rates were 92.1% (95% CI, 89.6%–94.7%) and 83.8% (95% CI, 79.8%–88.1%), respectively. Subgroup analysis found significant benefit for patients with miT0N0M0 disease (hazard ratio, 0.42; 95% CI, 0.22–0.78; <i>P</i> = 0.0061), particularly those with a prostate-specific antigen level of 0.5 ng/mL or lower (<i>P</i> = 0.03, log-rank test). <b>Conclusion:</b> SRT improves OS for patients with BCR, especially those with a negative prostate-specific membrane antigen–targeted PET.

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Journal
Journal of Nuclear Medicine
Published
2026-05-21
DOI
https://doi.org/10.2967/jnumed.125.271770
Primary Topic
Prostate Cancer Diagnosis and Treatment
Type
article
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article

Salvage Radiotherapy Confers an Overall Survival Advantage in Biochemical Recurrence of Prostate Cancer: Evidence from the International PROMISE Registry

Sazan Rasul, Matthias Miederer, Tobias Hölscher, Caner Civan et al.
Journal of Nuclear Medicine
Prostate Cancer Diagnosis and Treatment
article

Salvage Radiotherapy Confers an Overall Survival Advantage in Biochemical Recurrence of Prostate Cancer: Evidence from the International PROMISE Registry

Sazan Rasul, Matthias Miederer, Tobias Hölscher, Caner Civan, Jens Kleesiek, Andrej Vondrák, Maja Guberina, Jonathan Miksch, Sebastian Hoberück, Lale Umutlu, Adrien Holzgreve, Anja Merkel‐Jens, Martin Stuschke, Andreas Stang, Alfonso Santangelo, Andrea Farolfi, Lela Theus, Helen Scholtissek, Gabriel T. Sheikh, K Goffin, D A Pizzuto, K Herrmann, S Beintner-Skawran, M Eiber, A T Nguyen, Boris Hadaschik, Laura Evangelista, W Fendler, N Guberina, Kambiz Rahbar, Matteo Bauckneht, Andrea Di Giorgio, Marcin Miszczyk, Shima F. Reinwand, Isabel Rauscher, Madeleine J. Karpinski, Timo F. W. Soeterik, Anders Bjartell
article en

Abstract

The impact of salvage radiotherapy (SRT) on overall survival (OS) in patients experiencing biochemical recurrence (BCR) of prostate cancer remains an area of active investigation. The international multicenter PROMISE registry provides a valuable dataset to explore the association between SRT and long-term clinical outcomes in this patient population (NCT06320223). <b>Methods:</b> Comprehensive restaging at the time of BCR was performed by integrating both serologic markers and advanced molecular imaging (PET/CT or PET/MRI), offering an accurate assessment of molecular imaging (mi) TNM stage. <b>Results:</b> In total, 1410 patients experiencing BCR with prior prostatectomy were included. The median follow-up was 5.2 y (interquartile range, 3.8–6.9 y). SRT was administered after PET to 381 of 680 patients (56.0%) with PET-negative disease (miT0N0M0) and to 478 of 730 patients (65.0%) with PET-locoregional disease (miT/N+ M0). SRT was associated with longer OS in the entire cohort (hazard ratio, 0.66; 95% CI, 0.47–0.93; <i>P</i> = 0.019) with 5- and 7-y survival rates of 95.2% (95% CI, 93.6%–96.8%) and 90.8% (95% CI, 88.1%–93.6%), respectively. Without SRT, 5- and 7-y survival rates were 92.1% (95% CI, 89.6%–94.7%) and 83.8% (95% CI, 79.8%–88.1%), respectively. Subgroup analysis found significant benefit for patients with miT0N0M0 disease (hazard ratio, 0.42; 95% CI, 0.22–0.78; <i>P</i> = 0.0061), particularly those with a prostate-specific antigen level of 0.5 ng/mL or lower (<i>P</i> = 0.03, log-rank test). <b>Conclusion:</b> SRT improves OS for patients with BCR, especially those with a negative prostate-specific membrane antigen–targeted PET.

Journal of Nuclear Medicine
Humanitas University (IT), Vita-Salute San Raffaele University (IT), University of Augsburg (DE), Lund University (SE), University of Zurich (CH), Agostino Gemelli University Polyclinic (IT), University Medical Center Utrecht (NL), LMU Klinikum (DE), Constantine the Philosopher University in Nitra (SK), Institut für Medizinische Informatik, Biometrie und Epidemiologie (DE), Comprehensive Cancer Center Vienna (AT), University Hospital of Zurich (CH), St. Antonius Ziekenhuis (NL), University Hospital Münster (DE), Azienda USL di Bologna (IT), Essen University Hospital (DE), Skåne University Hospital (SE), WSB University (PL), Ospedale Policlinico San Martino (IT), Comprehensive Cancer Center Erlangen (DE), University Hospital Ulm (DE), Molecular Theranostics (United States) (US), West German Heart and Vascular Center Essen (DE), University Hospital Carl Gustav Carus (DE), IRCCS Humanitas Research Hospital (IT), Technical University of Munich (DE), Medical University of Vienna (AT), Ludwig-Maximilians-Universität München (DE), University of Genoa (IT), University of Bologna (IT), KU Leuven (BE)
Partnerships for the goals
Openalex Percentile: Top 6%
Prostate Cancer Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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