A study published in the Journal of Nuclear Medicine demonstrated that using PSMA-PET/CT imaging to locate disease before salvage radiotherapy significantly improves overall survival (OS) for patients experiencing biochemical recurrence (BCR) compared to treating based on PSA levels alone.Previously, doctors knew PSMA-PET was excellent at spotting exactly where cancer had returned, but they lacked concrete data proving that finding these spots actually helped patients live longer.

Traditional salvage therapy is often "blind," radiation is targeted broadly to the prostate bed based purely on a rising PSA. PSMA-PET reveals the exact coordinates of the recurrence, allowing radiation oncologists to aggressively target the true source of the cancer.
All this being said, this is clearly being debated and as is everything, one size does not fit all. Certainly each individual needs to be looked at, but patients on here have had their BCR found in other parts of the body besides the prostate bed, so radiation to the prostate bed without the direction from the PET scan would not have helped. All these numbers about Overall Survival are just that, because one that says 75% or one that says 80% does that really matter in regards to your thinking about quality of life. ADT destroys quality of life for many and if you don’t need to go on it for even an additional year, isn’t that worth it, if the outcome does not change. The statistics that 500 might be in this group or that group, is from thousands and thousands. Active Surveillance or Watchful waiting with lymphoma is not for everyone, especially high anxiety types. Their are many people diagnosed with Gleason 6 hearing cancer and cannot live with that thought and want surgery or radiation now. Their is also a debate about calling Gleason 6 cancer. Regardless of watching your PSA doubling time, I think what is important is the end overall survivability with your quality of life intact for as long as possible if it won’t affect the end result. The debate over PSA driven and Scan Image driven treatment for BCR reflects that scan image is becoming more prevalent and as even more long term studies come out, my belief is it will become standard. Remember ADT was once required 24 months, then 18, now even 6. Also everyone believed Gleason 6 had to be treated immediately also. It is up to each individual and their Oncologist to discuss these matters, but to believe any treatment will be the best in this ever changing environment whether the cancer guidelines say so do not take into effect current studies and the ever changing environment. These guidelines change based on what the studies show and if you are just locked in on what those statistics say, you might be missing out.