FOLH1 and metastatic neoplasm: In Group B, ISUP grade > 3 was the only predictor (p = 0.028).<h4>Conclusions</h4>ISUP grade > 3, time to BCR ≤ 26 months, pN1 status, and persistent disease after surgery indicated a higher likelihood of PSMA-positive metastatic disease in a homogeneous cohort of patients with biochemical failure and low PSA values.