Options —> There are a few questions you need answers to before you can answer those questions;

> What were your PSMA PET scan SUVmax scores prior to surgery?

> When you say “PET scan last week isn't very conclusive,” what does that mean? What were your post-treatment MRI SUVmax scores and where were the lesions? (Where will they know to target the radiation if they don’t know where the cancer is?)

The discrepancy in protocols is because PSMA PET scans aren’t very sensitive at lower PSAs. (See attached chart.) At a PSA if 0.2, PSMA PET will miss cancers about 66% of the time; at a PSA of 0.4, PSMA PET will miss cancers about 50% of the time. So some centers want to wait until there’s at least a 50/50 chance of there not being a false negative.

Dr. Kwon (of Mayo Clinic) indicates that only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence. He says to first confirm where the recurrence is. (See Dr. Kwon’s presentation about recurrence: https://youtu.be/Q2joD360_pI)

It’s not about only watching and waiting for the next PSA test:

> what was your pre-surgery biomarker (genomic) test result?

> what was your genetic (germline) test result?

> what was your post-surgery MRI result?

All of those (and maybe more) factor into your next treatment decision.