A landmark Phase II trial, LUNAR, reveals that combining PSMA-targeted radioligand therapy with stereotactic body radiation therapy (SBRT) more than doubles progression-free survival in oligometastatic recurrent prostate cancer compared to SBRT alone. UCLA’s Jonsson Comprehensive Cancer Center led this innovative approach, which integrates targeted radiopharmaceuticals to manage limited metastatic disease. Additionally, a genomic test now predicts benefit from adjunct hormone therapy post-prostatectomy, marking the first biomarker to personalize post-surgical treatment. These advances represent pivotal shifts in managing recurrent prostate cancer.