All the comments from the forum are solid gold and there are tens of thousands of men who’ve been in a similar situation - myself also.
I chose radiation and 6 mos ADT 6 yrs after surgery; I read all the literature, all the trials, all the 10 and 15 yr comparisons and outcomes and it all came down to one simple question:
What was I MORE afraid of - the radiation or the cancer?
That’s the only thing that matters when all is said and done.
You’re 68 -relatively young - and you could easily live another 20+ years. It’s taken your cancer 14 years to clinically recur, so how aggressive can it really be, right? However, you need to also consider your PSA Velocity. If it’s taken sudden jumps over the past year it could indicate a rapidly growing tumor or cluster of cells.
As @michaelcharles pointed out, PSMA scan at these low levels are not great; in fact, a few days ago a poster had a PSA of 10.0 and nothing showed!
You can certainly monitor your situation with 3 month PSA tests - any trend upward with increased velocity should make your decision easier. I’m no expert but 3 PSA’s over 9 months should not appreciably change your course if treatment should you go down that path. Best,
Phil