More of your clinical data would be useful in answering...

More and more. SRT to the prostate bed only in one who experiences BCR is not the standard of care, rather, SRT to the prostate bed and pelvic lymph nodes along with short term ADT is the "norm."

My experience with BCR and SRT was it happened 15-18 months afte a highly "successful" surgery when PSA first came back at .2, then 90 days later, .3.

I advocated, albeit, not very strongly for SRT to the prostate bed, PLNs and six months ADT. At the time it was not the SOC and my medical team said there was no long-term data to support it. I discussed the data Mayo had showing that in high-risk patients more often than the BCR had already spread to the regional lymph. nodes.

In my latest recurrence m y medical team and I had decision criteria about when to image, three or more consecutive increases in PSA spaced 90 days apart and PSA between .5-1.0. When my third increase hit .48, radiologist said close enough. I said, no, wait for the next one. It was .77, we imaged, it showed a single PLN which we hit with SBRT and added 12 months Orgovyx to deal with micro-metastatic disease too small to be seen on imaging. Would imaging at .48 have shown the same thing, we'll never know. But the risk-=benefit of waiting was favorable in my eyes, so we did.

Your choices at this point are to initiate treatment or wait.

If you and your medical team decide to initiate now based solely on PSA, then consider a more aggressive approach of prostate bed, pelvic lymph nodes and six months ADT.

If you decide to wait and image again, you may have more clarity about where the recurrence is which can inform your treatment decision.

There is some data that in low risk PCa doing "nothing" but actively monitoring is an option given the time to onset of metastases, There is also data that says in low risk PCa, MDT can delay the need for ADT.

For intermediate and high risk PCa, those options are still possible but more likely you move to SRT to the prostate bed and PLNs and include short term ADT which can include an ARI.

Intuitively, the higher one's PSA, the greater statistical probability imaging locates the recurrence

I acquiesced, SRT to the prostate bed was an epic failure. I would graduate to triplet therapy. Would the outcome of SRT been different had I stuck to my guns, we'll never know but intuitively, yes.

This may help - https://www.urotoday.com/conference-highlights/eau-2025/eau-2025-prostate-cancer/159158-eau-2025-how-to-optimize-outcomes-in-men-with-biochemical-recurrence-after-local-treatment-with-curative-intent.html

Kevin