After having radiation, the rule is if you’re PSA rises two points above the lowest it ever hit after radiation then you need treatment. 6.5 is way beyond that.

It sounds like somebody is not watching your case closely considering you now have a 6.5. You really do need to do something because you may find out that prostate cancer is extremely painful if untreated.

You don’t mention how old you are, I took ADT for Eight years and stopped at 76 only because my testosterone will probably never come back So taking ADT is no longer beneficial. If my Testosterone rises to 100 I will start back on ADT. Sure, I don’t like the side effects, but I’m alive and undetectable after 15 years And four relapses. ADT will stop your cancer from growing and probably shrink it.

Not uncommon for the PET scan to show nothing. If the radiation you had only targeted the prostate, then you can have the prostate bed radiated, A likely spot for the Rising PSA.

Be aware that the PSMA Pet scan Can only see metastasis that are larger than 2.7 mm. In some cases they can’t even see them if they’re 5 mm or below. You could have metastasis that just cannot be detected yet. The PSMA pet scan can also not see metastasis that do not produce PSMA. About 10% of people have metastasis like that and you need a different pet scan to see them, Not saying that you but something to consider.