Thought experiment: Let's take a very simple hypothetical trial involving 100 patients in the APA arm and 100 patients in the ADT alone arm. Pulling from PROTEUS EFS data, assume that, by 5 years, 60 patients in the ADT arm have had a BCR compared to 50 in the ADT+APA arm. Assume they all get imaging at around the same, low PSA. A 2025 ASCO GU abstract of 217 post-RP patients found that at comparable median PSA values (~0.23–0.25 ng/mL), 52.7% of PSMA PET scans were positive versus only 9.9% of conventional imaging studies. Using those probabilities of detection, assuming M1 in all detected cases, and the differential PSMA PET utilization from the paper (~64% in the APA arm and 72% in the ADT arm), the MFS benefit at 5 years would be approximately 5.3%. If PSMA PET was utilized equally in each arms (72% in each), the MFS benefit at 5 years would be approximately 3.5%. Math in the excel screenshot below :) Would this reduction in MFS benefit (delta of deltas= 1.4%) tip these hypothetical results from significant to non-significant? To me, this would be an interesting sensitivity analysis to run. #ASCO26 #radonc #medtwitter #pcsm