The PORTAL study establishes an international, validated nomogram to predict androgen deprivation therapy (ADT)-free survival in men with PSMA PET-detected oligorecurrent prostate cancer.
Key independent predictors of earlier ADT initiation include higher pre-treatment PSA, shorter PSA doubling time (PSADT), a higher number of lesions (3–5), and the presence of distant versus nodal-only metastases.
While individual-level discrimination was modest (C-index 0.65–0.66), the tool successfully stratified patients into three distinct prognostic groups, facilitating more personalized Metastasis-Directed Therapy (MDT) decisions.
MDT using SBRT achieved a 1-year ADT-free survival rate exceeding 84%, reinforcing its role in delaying systemic therapy and its associated side effects.
