You have had a lot of important points, Chuck. With your low PSA it sure seems you should wait until you have a fast Doubling time, and your PSA is higher, before you start worrying about the options below. You are at .2, How fast did it get there?

Here are Some things that relate to having Reoccurrence with or without metastasis

At the recent PCRI conference it was mentioned that only 1/3 of the people that get salvage radiation benefit from it, In that they have no further remission.

Both Dr. Kwon and Dr. Scholz Are real enthusiasts about using SBRT to just zap the metastasis and you can go home happy and not worrying about it.

These two things sort of collide together. Currently the SBRT scan cannot see metastasis smaller than 2.7 mm and in some case even at 5 mm It can’t always be determined (from recent UCSF conference).

That means you could be waiting for metastasis to show up while many other mini metastasis are growing. Because the prostate is removed the area around there is the most likely place that something could have microscopically spilled and be spreading. As was mentioned in the PCRI conference “Seeds for metastasis were already there when surgery was done, waiting to grow.” That’s where salvage radiation becomes to make some sense.

It could be the C11 scan can detect smaller Metastasis.

Dr. Scholz was real emphatic, At the PCRI conference, about using the SBRT technique to keep his patients in remission.

So now you have a little bit of both sides of that story.

As for adding ADT if you’ve had a metastasis or remission, ADT is normally the recommended treatment. Even an ARSI may be used at the same time if the cancer looks like it could be aggressive.

Here is a treatment guide I got from one of the Conferences.. Anti—hormones is referring to drugs like ADT.