@wheel1

"The study confirmed that men who received a PSMA-PET scan before radiation had a statistically significant improvement in overall survival (OS) compared to those who did not. "

Did you mean to say "men who had positive PSMA scan" ?

I do not understand purpose of this study otherwise ? WHO in the world has salvage RT without first having PSMA done 😵‍💫 ?

Regarding official guidelines - I mostly read studies and make my opinion based on them. Unfortunately doctors are following "standard of care" and can not prescribe novel therapy unless it is approved. So yes, some things are outdated but some show very clear picture in randomized trails and from multiple institutions across the world. One of those is : early salvage (before 0.5) regardless of PSMA being negative with RT to the whole pelvic floor PLUS nodes , PLUS ADT shows much superior results for majority of patients.