How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?

It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including other imaging findings (especially pelvic MRI), PSA at the time of referral, time from surgery to rise in PSA, PSA doubling time, Gleason score, status of margins, seminal vesicle invasion, extracapsula...

A negative PSMA does not change my treatment recommendation. I use a mix of PSA and pre-op factors to decide whether I recommend elective nodal irradiation (ENI), along with a fair amount of shared decision making (SDM) with the patient and at times with Urology (who administer ADT but not NHT at my institution).

A non-exhaustive synopsis of my discussion with patients as follows (I am not routinely using Decipher testing at the current time based on current evidence base, pending results of ongo...

I would consider ENI and 24 months ADT for PSA > .5, GS 8 and above, or a high decipher score.