I recommend considering these inputs. They help to explain potential next steps, when, and why. At your level of PSA, the challenge is knowing where to radiate.
"What to ask when PSA is rising after the initial treatment:"
PCF - https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/psa-rising/what-to-ask-when-your-psa-is-rising-after-initial-treatment/
"Rising PSA after initial treatment. PCRI" - https://www.youtube.com/watch?v=X_FtOBTIOj0

Here's my clinical history.

After surgery in 2014, I had BCR. At the time, the standard of care was SRT to the prostate bed. Yet, there was data and evidence emerging from CTs and Mayo that including short term ADT and extending the radiation to the pelvic lymph nodes was a better option since they were finding more often, BCR actually included disease outside the prostate bed.

I discussed this with my radiologist and urologist, they dismissed the idea, no long term data they said, not in the NCCN guidelines, wasn't mainstream clinical practice. I acquiesced and you can guess the rest of the story, I was right, too bad I was.

So, starting point would be to familiarize yourself with the NCCN Guideines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

You can also do literature searches on doublet and triple therapy - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc

Next, the forum will need your clinical data, pathology report for example to provide you feedback. The answer in part lies in your risk category.

All that being said, you'll have choices, what you choose will in part be what your medical team recommends and in part what's important to you - going for a cure, quality, quantity of life, financial toxicity associated with treatment...

You could do nothing, there is some data that says it may be up to eight years before you have metastases, remember, risk category!.

You could do treatment to the prostate bed only, radiation, there are plenty of choices there too, IMRT, SBRT...

You could be aggressive, do SRT, extend it to the PLNs, add short term ADT, say six months.

If not already, you may want to add an oncologist to your team to get further medical input (I am not a medical expert!)

Kevin, I have been following your story and agree with you points. My Gleason score was 3+4 with one node positive. Duration to bcr was 3 years. Had mri ( negative) and PSMA pet showing suspicious spot where seminal vesicle was removed. I had negative margins. RO at mayo recommended srt and 4 months adt. His success rate with patients similar to me was 85% meaning that, after this treatment, cancer is gone for life, never to return. I guess we will see. Seamed like an easy decision to me.

Good Luck to everyone. Each of us are all different

🙏🙏🙏

has any one used xtandi drug for cancer

PSA went from 12 to 6 in 3 months after eligard injection.Is this normal decrease or should it have been more?

Some more "homework..."
https://www.urotoday.com/conference-highlights/asco-gu-2024/asco-gu-2024-prostate-cancer/149342-asco-gu-2024-systemic-treatment-of-high-risk-biochemical-recurrence.html?utm_source=newsletter_12512&utm_medium=email&utm_campaign=emerging-evidence-in-localized-and-recurrent-prostate-cancer-genomic-insights-novel-therapeutics-and-enhanced-detection-strategies-asco-gu-2024

Psa 1.8 then 2.2 post surgery. Got put on adt and psa dropped in 30 days undectable 11 months later. Drs want pelvic radiation therapy now.

You may also be interested in these discussions related to rising PSA: https://connect.mayoclinic.org/group/prostate-cancer/?search=Rising+PSA#discussion-listview

- Rising PSA years after radical prostatectomy
https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/
@mmuise1, any update? What next steps has your cancer team suggested for you?

Had aPSMA PeT to rule out spread or if we can find the cancer if no spread there will offer salvage radiation for cure while you’re numbers are still low good luck