Abstract Purpose The aim of this study was to investigate whether an early, accurate identification of disease using ¹⁸F-DCFPyL PET/CT imaging resulted in a change of decision on treatment management, for individual patients with biochemically recurrent (BCR), hormone-sensitive prostate cancer. Methods In this retrospective study, a total of 253 patients with BCR who underwent restaging ¹⁸F-DCFPyL PET/CT were assessed. Two urologists specialized in uro-oncology were asked to formulate a preferred treatment for each patient before and after knowing the results of the ¹⁸F-DCFPyL PET/CT. Results Out of 253 patients, 191 (75%) underwent robot-assisted radical prostatectomy (RARP) as primary therapy, and 62 (25%) external beam radiation therapy (EBRT). In 103/253 cases (40.7%), a preferred treatment change based on the ¹⁸F-DCFPyL PET/CT findings was reported. In patients post-RARP, a positive ¹⁸F-DCFPyL PET/CT (OR 6.21; 95%CI 2.78–13.8; p < 0.001) and positive pathological lymph node status (pN1) (OR 2.96; 95%CI 1.15–7.60; p = 0.024) were significant predictors for an intended change of management, whereas a positive surgical margin (OR 0.42; 95%CI 0.20–0.88; p = 0.022) was inversely associated with an intended change of management. Conclusion In this study, we found a significant impact of ¹⁸F-DCFPyL PET/CT on the intended management of patients with biochemically recurrent hormone-sensitive prostate cancer. A positive ¹⁸F-DCFPyL PET/CT scan, positive pathological lymph node status, and a negative surgical margin status were significantly associated with increased odds of having a change of management based on ¹⁸F-DCFPyL PET/CT findings.