Negative findings on PSMA scan

Unfortunately, none of the diagnostic scans are 100% accurate. I had a BCR after my RP and before we started the radiation treatments did the PSMA which was negative. The climbing PSA had my surgeon convinced that there was still some cancer cells present.
We started the salvage radiation and ADT (hormone therapy) at that time.
I don't know how many PSA tests you've had showing the upward trend, but if the trend is definitely there. It's likely time to start thinking about ADT again at a minimum.
I believe some docs may wait till the PSA rises a little further to try the PSMA again. I'll upload this chart again that was shared by another member. This will demonstrate why they may want to repeat the PSMA when / if the PSA gets a little higher. It seems the lower the PSA the more likely the test to be negative.
Best of luck to you!

The scans are a huge leap forward in the identifications of recurrence and informing treatment decisions. That being said, they do not always show where the recurrence is even with rising PSA.

For once, I was "lucky" and my Plarify scan showed where the recurrence was. That enabled my radiologist to use SBRT for MDT. However as web265 shows (I recognize that chart!), that was likely not the only place my PCa was so we added 12 months of systemic therapy to deal with the micrometastatic cancer, too small to be seen by the Plarify scan. As of today, I m five weeks out of ending this cycle of treatment if my final labs come back undetectable.

Don't quote me on this because I can't find the literature but in the dusty basement of my mind I faintly recall that PSADT may be a factor in imaging. Mine has always been < 3 months, from what you describe, yours may be >12 months, talk with your medical team.

So, decisions...
Do you wait and try again, what's the risk, would it change your treatment decision...?
Do you start hormone therapy now as a monotherapy (generally, doublet or triplet therapy is more mainstream but your clinical history may argue for monotherapy) based only on rising PSA...https://www.dovepress.com/evolution-of-androgen-deprivation-therapy-adt-and-its-new-emerging-mod-peer-reviewed-fulltext-article-RRU...?
Do you wait to start hormone therapy until you are symptomatic?
Do you do WPLN... and short term ADT, 6,1 2, 18 or 24 months...?

Part of that decision resides in factors such as co-morbiidities, life expectancy, quality versus quantity of life, your clinical data, PSADT is a big one...

Kevin

I will be having my 4th PSMA Pet scan next week.
My PSA post RRP was 0.37, 6 months later PSA was 0.69 so then 34 rounds of Salvage Radiation to the prostate bed. PSA after Salvage Radiation went up to 1.29. PSMA PET scan did not show any mets. Then 10 months of active surveillance as PSA continued to rise up to 6.56 another PSMA PET was ordered and a metastatic lymph node was found in my chest. Then I did a clinical drug trial with Orgovyx and Erleada with 5 rounds of radiation to met. PSA at the completion of trial was < 0.01, then 12 weeks later it was up a bit to a PSA of 0.02, and then 4 weeks later PSA was up to 0.08. At that point my oncologist said the PSA was too low for anything to show up on the PMSA PET. We had already plan on doing one at the PSMA PET 6 months after the trial end. That's where we're at now...
I have only been on this journey for about 3 years.

I’ve been on this up and down journey for 18 years. I personally believe that this cancer is not curable. It just goes into remission for a while and or years. Just my opinion. 🤷‍♂️

May be inflammation of the system?