There is a separate (and very active) prostate cancer group here at Mayo connect. You are welcome to join us, and you'll get a lot more feedback there.
https://connect.mayoclinic.org/group/prostate-cancer/

Welcome, @kenporter. I moved your message to the Prostate Cancer support group to this particular discussion:

- Outside of PSMA scans what tests are important to new patients? https://connect.mayoclinic.org/discussion/outside-of-psma-scans-what-tests-are-important-to-new-patients/

I think you'll appreciate the comments shared. You can also use the group search to find additional discussions related to you. For example:
- Discussions related to PMSA scan https://connect.mayoclinic.org/group/prostate-cancer/?search=PSMA&index=discussions
Discussions related to Gleason 7 https://connect.mayoclinic.org/group/prostate-cancer/?search=Gleason%207&index=discussions

Your age and cancer stage are definitely criteria to consider along with quality of life when making treatment decisions. Did your cancer team help with submitting the appeal to insurance?

medicare will pay for the Pet scan ( do you have an advantage plan ?) Continue with your doctors appeal and get whatever appeal paperwork that you might need should your medical team appeal is unsuccessful. Also, consider a letter to your congressman so that they might intervene. Take no crap from your insurance company and it is good if you get the reputation of a demanding but polite policyholder. The pet scan will better determine where the cancer is and how extensive and then the appropriate treatment. With appropriate treatment I suspect that PC will not kill you Good luck

kenporter,
I think the decision will be reversed on appeal. Pylarify is the newest contrast agent and the most expensive. Insurance companies like to deny everything.
You may well die of something else because cancer treatments have improved greatly and you 'd better plan on more than ten. In another year you'll be outliving women 3 to 1.
I also think that it is great that you have 0 nodes. They will need to treat the seminal vesicle and since you've invited me to think, I think you should look at radiation with a Viewray Meridian.
https://www.nyp.org/locations/david-h-koch-center/mri-guided-radiation-therapy

We all have to decide what is best for us and the quality of life we want both physically and mentally.

I was 76 when I got diagnosed with prostrate cancer and did not hesitate to have proton radiation to cure it. I expect to live a very long life so what ever I needed to do to stay with that plan I was going to do.

Statistics are just that. There is no definite time frame for life expectancy. Live expectancy were and are based on statistics not individuals. Thus some life expectancies will be less and some more. Think positive and have your mental outlook as I am in the more class.

A PSMA will show areas outside your prostrate gland have been invaded. It is a good test and I think should be standard with any prostrate diagnosis. Another test to consider is bone scan. Another Decipher which is help diagnose your cancer risk level and appropriate treatments.

Good luck!!!!!