FOLH1 and posterior cortical atrophy: At 5 years, bPFS was 66.8% in PSMA-negative patients (undergoing SRT+/-HT) vs. 26.7% in PSMA-positive patients (any treatment).<h4>Conclusion</h4>PSMA-PET led to management changes in nearly one-third of post-prostatectomy recurrent PCa, notably affecting RT strategies and systemic therapy.