PSMA-PET detected any distant metastatic disease (miTxNxM1) in 34% of patients (31 of 91) after RP, 56% of patients (22 of 39) after dRT, 60% of patients (31 of 52) after RP and SRT, and 46% of patients (84 of 182) overall, and M1 status was significantly less frequent in the RP group (34% [31 of 91] vs 56% in the dRT group [22 of 39], 60% in the RP and SRT group [31 of 52], and 46% overall [84 of 182]; P = .005). This evidence concerns the gene FOLH1 and metastatic neoplasm.