Post prostatectomy PSA

You definitely should be getting a PSA test sooner. The standard is that once your PSA hits .2 you should be getting salvage radiation. I went 3.5 years after surgery Before my PSA hit .2 and I had salvage radiation, Then I went 2 1/2 years before it came back again.

What was your Gleason score, That is a big factor in deciding what to do.. As long as you went after surgery, it was probably a seven.

A PSMA PET scan works better With a higher PSA than you have. It may not find anything, even if you have a small metastasis. You should consider going to a center of excellence, Your current doctor may not be Following the standards that are set.

Of course, the PSMA will probably be done but it only begins to show anything at .5 or above….NOT suggesting no treatment before that .5, but just know that the scan has limitations.
You probably need ADT/salvage radiation (as I am having done 5 yrs after surgery with PSA of .18) but that’s a choice you will make with input from your oncology team…Best

90 days after RP, my PSA was "persistent" at .19 (repeated 30 days later at .18).
My surgeon referred me to a Radiation Oncologist. PSMA PET scan (approx 25 - 30% detection @ that PSA level) did not show any clear local or distant metastases, therefore the belief was that PCa remained in the prostate floor and/or pelvic lymph nodes.
Began Salvage Radiation Treatment to whole pelvic area (WPRT) and pelvic lymph nodes w/ short term ADT (see SPPORT trial).
I had 37 IMRT radiation sessions and 4 mos Orgovyx.
6 mos - 18 mos post salvage radiation, 5 90 day interval uPSA tests < .02 (undetectable).🤞
My understanding is that the sweet spot for salvage treatment is .2 -
.4/.5 PSA, and the trend has been to treat BCR on the earlier side.
My layman advice would be to consult with a Radiation Oncologist, who may order another PSA test and possibly a PSMA PET scan to rule in/out distant metastases and discuss initiating Salvage Radiation Treatment.
Many on this site, including me, have sought care at a recognized Center of Excellence, although there are also very good local facilities.
Best wishes.

Well, depends on your clinical data...

May be useful if you have the pathology report - Gleason Score, Grade Group Margins, ECE, SV, % of involvement...

You can use the MSKCC PSADT and PSAV nomogram to calculate those.

"My spouse, she thinks I should lobby to get a PET scan now..." You can ask your medical team, but...at your current PSA, less than 1/3 chance of locating any recurrence. A question to discuss with your medical team is what risk is there in waiting for one or more PSA tests spaced three months apart, PSA between .5-1.0, then image?

The clinical data from your pathology report combined with your PSADT and PSAV and results from imaging may inform your discussions with your medical team and provide members of this forum the data needed to provide you assesment and feedback on treatment options to discuss with your medical team.

The only negative pieces of clinical data are you have PCa, had surgery and less than two years to BCR.

The PSAs you provide are an indication of activity and BCR. A third test may be evidence of a continuous upward trend (mine has gone up, then down before) and if high enough, provide results from imaging.

You ask..."But I would really like to know is how you guys attack this when it was low." My answer, don't (but that's me as layman and what I would do) but discuss with your medical team! I would consider waiting for that next PSA test and a PSA high enough, say between .5 to 1.0, image, then armed with that clinical data and your history, decide in consultation with your medical team on if treatment, when, with what, for how long.

That treatment may be doublet or triplet - ADT + ARI and chemotherapy. It may include radiation. As to when, well, nobody can say, depends on the clinical data.

I am not a trained, educated or board-certified medical expert, a layman, member of this darn club but I have learned from the school of hard knocks!

Kevin