Similar case: a ‘low’ 0.36 PSA, 17 yrs post RARP, and PSMA Pet shows metastasis to lung. So, similar with lower PSA being expressed with metastasis.

We have not been offered SBRT. We asked and the notion was to get going with ADT and chemo fearing some odd mutation that isn’t showing itself. From what I’ve read SBRT sounds like a good option with less collateral damage and ablation is another treatment that we may consider if there are residual spots after this chemo hit (again, need to talk with team about it).

As for salvage radiation, it was offered before we had the PET scan, as a ‘standard post surgery tx’ when PSA creeps up. We pushed for imaging and glad we avoided radiating the prostate bed because nothing showed up there on MRI or PET. Are there ca ‘seeds’ or stem cells unseen somewhere? Probably, but we are now learning that chemo and radiation may get the dividing cells, but not the stem cells, as prostate cancer cells are heterogenous. Those buggers are the ones that ‘come back’ or become resistant and the ones that need an attack still tbd, it seems. That’s why this has become like a chronic illness and long term battle. This is just my view from a lot of reading, others may agree or disagree.

Anyway, whack a mole with SBRT seems a promising option to consider and avoiding random radiation to areas without confirming tumor presence sounds like something to dig into with more questions.

Good luck and keep us posted. We low PSA with Mets are in a special group. Others here with Cribiform can tell you more about that. Our surgery pathology was 2008 and they did not look for that at the time, although we did have PNI (another interesting rabbit hole).

Wow, sorry, I carried on …