Prostate-specific membrane antigen (PSMA)–targeted radioguided surgery (RGS) is evolving as a new treatment modality for patients with early biochemical recurrence of prostate cancer and disease limited to locoregional lymph nodes on PSMA-ligand PET/CT. Nevertheless, the pattern of failure (locoregional vs. systemic) after PSMA RGS remains unknown. Therefore, the aim of this retrospective analysis was to evaluate the pattern of disease using PSMA-ligand PET in patients experiencing relapse after PSMA RGS. Methods: We evaluated 100 patients with biochemical recurrence after previous PET-guided PSMA RGS who underwent PSMA-ligand PET (median prostate-specific antigen [PSA], 0.9 ng/mL; range, 0.2–14.2 ng/mL). All suspicious lesions for recurrent prostate cancer were grouped according to the molecular imaging TNM classification system. Detection rates and lesion localization were determined and stratified by PSA values and the International Society of Urological Pathology grade group. Further, lesion localization was compared before and after PSMA RGS. Results: The median time between PSMA RGS and PSMA-ligand PET for relapse was 11.4 mo (range, 5.5–25.6 mo). In total, 91 of 100 (91%) patients showed PSMA-ligand–positive findings. PSMA PET detection rates were 82.6%, 92.6%, 91.3%, and 96.3% for PSA levels of 0.2–0.49, 0.5–0.99, 1–1.99, and at least 2 ng/mL, respectively. More than half of the patients (53%; 48/91) showed local recurrence or pelvic lymph node metastases only. Extrapelvic lymph node metastases, bone metastases, and visceral metastases were present in 22% (20/91), 16% (15/91), and 9% (8/91) of the patients, respectively. With increasing International Society of Urological Pathology grade group, the percentage of patients with bone and visceral metastases increased, whereas the number of patients with only locoregional disease decreased. Conclusion: PSMA-ligand PET is a useful method to detect and localize recurrent disease in patients with biochemical failure after PSMA RGS, with more than half of the patients presenting with locoregional recurrence, offering the potential for a second local therapy (e.g., radiation therapy or repeated surgery).

前列腺特异性膜抗原 （PSMA） 靶向放射引导手术 （RGS） 正在发展成为一种新的治疗方式，适用于前列腺癌早期生化复发和仅限于 PSMA 配体 PET/CT 上局部区域淋巴结的疾病患者。然而，PSMA RGS 后失败的模式 （局部 vs. 全身） 仍然未知。因此，本回顾性分析的目的是使用 PSMA 配体 PET 评估 PSMA RGS 后复发患者的疾病模式。方法：我们评估了 100 例既往 PET 引导下 PSMA RGS 后接受 PSMA 配体 PET 的生化复发患者 （中位前列腺特异性抗原 [PSA]，0.9 ng/mL;范围，0.2-14.2 ng/mL）。根据分子影像学 TNM 分类系统对所有复发性前列腺癌的可疑病变进行分组。通过 PSA 值和国际泌尿外科病理学会分级组确定和分层检出率和病变定位。此外，比较了 PSMA RGS 前后的病变定位。结果：PSMA RGS 和 PSMA 配体 PET 之间的中位复发时间为 11.4 个月（范围，5.5-25.6 个月）。总共 100 例患者中有 91 例 （91%） 显示 PSMA 配体阳性结果。PSA 水平为 0.2-0.49、0.5-0.99、1-1.99 和至少 2 ng/mL 时，PSMA PET 检出率分别为 82.6%、92.6%、91.3% 和 96.3%。超过一半的患者 （53%;48/91） 仅显示局部复发或盆腔淋巴结转移。盆腔外淋巴结转移、骨转移和内脏转移分别见于 22% （20/91） 、 16% （15/91） 和 9% （8/91） 的患者。 随着国际泌尿外科病理学会分级组的增加，骨和内脏转移患者的百分比增加，而仅局部区域疾病的患者数量减少。结论：PSMA 配体 PET 是检测和定位 PSMA RGS 后生化衰竭患者复发性疾病的有用方法，超过一半的患者表现为局部区域复发，为第二次局部治疗（例如放疗或重复手术）提供了潜力。