Recently, the landmark proPSMA randomized trial showed that PSMA PET/CT was more sensitive and specific than conventional imaging for nodal and distant metastatic disease in patients with high- and very high-risk prostate cancer.7 Furthermore, 2 recent studies20,21 reported an association between lymph node positivity on preoperative PSMA PET/CT and persistently elevated PSA level or BCR after RP, although no studies to date that we are aware of have reported on the association between PSMA PET/CT and long-term outcomes such as DM or PCSM. This evidence concerns the gene KLK3 and Familial prostate cancer.