(UroToday.com) The advent of positron emission tomography using radiolabeled prostate-specific membrane antigen (PSMA) ligands, called PSMA-PET, is rapidly changing prostate cancer staging imaging. However, as all published randomized clinical trials and studies to date have utilized conventional imaging, the impact that PSMA-PET clinical upstaging should have on treatment is unknown. To address this question, the authors present the PRIMORDIUM trial in progress (NCT04557059), which specifically evaluates the benefit of adding the androgen receptor inhibitor apalutamide to testosterone suppression and radiotherapy in patients experiencing a “high-risk” biochemical recurrence after radical prostatectomy.