My 1st 90 day postop PSA was .19 and led directly to Salvage Radiation Treatment. All at Johns Hopkins.
Postop path G 9 w/ EPE.
Recurrence is roughly defined as PSA of .2. Sweet spot for treatment has been .2 - .4/.5
However it appears trend is to treat sooner.
A friend 5 yrs postop with PSA < .2 just initiated Radiation at a MD Anderson facility in NJ w/o ADT.
I had a short term course of 4 mos Orgovyx (see SPPORT trial).
Whether to add ADT hormone therapy is an important Q.
If a PSMA pet scan "rules out" distant metastases, then the belief is that the cancer cells are in the prostate floor and pelvic lymph nodes and those areas can be radiated.
Issue is the PSMA scan is only about 20 - 30 % accurate at PSA level of .2
Personally, I would want to initiate Radiation sooner than later. And I had 37 IMRT txs to the whole pelvic region together with the pelvic lymph nodes. The longer tx time with lower Radiation caused some mid treatment bowel discomfort and diarrhea, which disappeared 2 - 3 wks after treatment.
There also seems to be a trend of ROs/MOs ordering shorter courses of ADT or none. Certainly I do not know what is right for you. However I think that my ADT SEs were more prominent than my radiation side effects.
6 mos after completion of treatment with both however, my PSA was < .02 and I had recovered 90% from the SEs and traveled to France for 2 weeks.
Best wishes on your decisions.