The median ADT-FS was 31.0 months (95% CI 20.1–41.8; Fig. 5) and multivariate analysis showed that patients with bone metastases, compared to patients with only lymph node metastases at the first PSMA PET-directed RT, had a significantly higher chance (p = 0.007, OR 4.51; 95% CI 1.8–13.47) of needing ADT at the last follow-up visit. Here, FOLH1 is linked to metastatic malignant neoplasm in the lymph nodes.