At a median follow-up of 24 months following initial PSMA PET scans, 73 of the 226 patients studied had clinical recurrence (CR). The 3-year CR-free rates in the 109-person metastasis-directed therapy (MDT) group were 51% and 28% in the no MDT group (117), respectively. Men who did not receive MDT had a significantly higher rate of distant metastases at CR than those who did (86% vs. 77%). The proportion of distant metastases was significantly lower in the MDT group (67% vs. 76%).