- Design
- Secondary analysis of a randomised trial
- Population
- 157 men with PSA recurrence after prostatectomy completing salvage radiotherapy
- Primary outcome
- Failure-free survival up to 48 months
- Effect
- PET-guided arm FFS 81.5% and 73.0% vs 64.0% and 45.3% with conventional imaging
This secondary analysis, published 15 September in Cancer, comes from a trial that randomised men with detectable PSA after prostatectomy to salvage radiotherapy planned with conventional imaging or with 18F-fluciclovine PET/CT, followed for up to 48 months. The analysis focused on race, socioeconomic status and metabolic dysregulation.
Failure-free survival was higher in the PET-guided arm for both African American men (81.5% vs 64.0%) and men of other races (73.0% vs 45.3%). African American men had better failure-free survival than other men overall (72.8% vs 58.7%) despite lower socioeconomic scores and higher allostatic load — a result the authors attribute partly to equal access within the trial.
The race finding is a subgroup analysis of a US trial and does not translate directly to Indian practice. The more portable point is that PET-guided planning of salvage radiotherapy was associated with better outcomes than conventional imaging in both groups.
- Molecular PET-guided planning was associated with better failure-free survival after salvage radiotherapy.
- Consider PSMA or fluciclovine PET before salvage radiotherapy where available.
- Equal access to care within a trial removed the usual disadvantage seen in some groups.
- The racial subgroup comparison is secondary and small.
Why it matters
Supports molecular imaging in salvage planning and shows how access, not biology, drives some outcome gaps.
Don't overread it
A secondary subgroup analysis; the race comparison was not the trial's randomised question.
The statistics, in plain English
Subgroups had only 26–52 men each, so the confidence intervals are wide — for example 34% to 83% for one group — and comparisons between races are imprecise.
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