Hello All, its been about a month since I posted and many things have occurred since then. So a bit of a recap-
I "skipped" seeing my Dr for 3 years - a mistake for sure. I went in on another issue and he wanted to run a blood profile which among other things said my cholesterol was too high and my PSA was 8.75 This was up from 4.25 3 years previously. So off to the urologist I went 3 weeks later and my PSA was 7.75 but DRE was indicating a very large prostate.

Had an MRI which showed pRADs 4 lesion plus some suspicious lymph nodes. To top that off I found out that I had something called a pelvic Kidney from birth which means my left kidney sits to the left and above my bladder. I have Chronic Kidney disease stage 2 as well from blood clots during a near death Covid encounter in 2020.

Since then the MRI prompted the Guided Biopsy with 6 of 14 cores positive with one core 4+3=7 at 50% GS 4 which pushed me into unfavorable intermediate risk.
Decipher Score took 2 weeks to arrive and said I was low risk at .41.

Back to my GP to discuss my cholesterol again and ran another PSA, this time 6.95
This was all followed up with a PSMA PET scan with Pylarify. That came back totally clean, I mean nothing even in the prostate!

Had a consult with my urologist then to discuss all this. His concern was due to the size of the prostate (106cc) and the pelvic kidney surgery could be problematic, He did say he would be willing to give it a shot which did not instill confidence in me what so ever. I asked about the PET scan being negative and he said he did understand that either. I said I wanted to talk to an RO and so I got a a referral.

Talked to the RO and he said that because the PET scan was questionable, the questionable lymph nodes remain suspicious. He had no answer for that either but was going back to the radiologists of the MRI and the PET Scan for further definition. The PET scan however showed no change in their size from the MRI 8 weeks previously. My RO feels they may be a non issue but wants to rule them out somehow. So then we had the what if talk, in other words if the lymph nodes were ok. He recommend EBRT with ADT for six months noting that the gland needs to be shrunk, He also mentioned a new procedure to shrink the prostate used mainly for BPH which I have a lot of called PAE or prostate artery embolism that they do. In this procedure they go in with an arterial catheter and place plastic balls in the specific arteries that feed the prostate which causes it to partially die. A 2 hour outpatient procedure. My RO is going to present my case to a group of other oncologists to get their response and recommendations.

So my questions to this community:
Has anyone else had a fully negative PET scan like this in spite of a positive biopsy?
Anyone with experience with the PAE?
Do you think my RO is correct about the treatment plan given the data?
Thanks for wading through all this - lots of great experience here!

I plan on getting a second opinion from Mayo or even move my treatment there.