At the latest PCRI conference this was brought up.

When PSA rises but can’t be found in the PSMA Pet scan, do an MRI, it will be found in Retroperitoneum or lung with high frequency

That is just one suggestion. Some people do not produce PSMA, So a PSMA PET scan doesn’t show anything.

It is recommended that people get an FDG Scan to see if they can find metastasis that are not seen by the PSMA pet.

I’m surprised your doctors let your PSA get so high. They should’ve implemented treatment at much lower levels of PSA, And it’s almost malpractice to not put you on ADT after having salvage radiation With a Gleason nine and cribriform!

The thing is the PSMA pet scan cannot see metastasis smaller than 2.7 mm and even at 5 mm. They are frequently missed. Your husband could have multiple small metastasis that just cannot Be seen, yet.

Where are you being treated? I cannot imagine a well trained oncologist having you have reoccurrences doing Salvage radiation and then not giving you ADT with a Gleason nine. You really need to look for a new medical team. You’ve got a very deadly disease that is not being treated properly. You want to go to A center of excellence or find a Genito urinary oncologist, The ones that specialize in prostate cancer. Medical oncologist treat all different types of cancers so they cannot keep up with the latest things going on in prostate cancer.

Your husband may be a case that Pluvicto could help with. They could find the small metastasis and destroy them. That only works if they have PSMA, And in your case, that is not clear.