I had undetectable PSA (< 0.1) for ten years after my radical prostatectomy. Then this past June, my PSA came in at 0.11, and three months later it is still 0.11 (and an ultra-sensitive test came in at 0.096). Because I had a small, palpable nodule in the prostatic fossa, my urologist ordered a PET PSMA scan in June. Even though my PSA was low for a PET scan, the nodule lit up like a Christmas tree on the scan (SUV =13). A follow-up MRI with contrast confirmed the lesion/nodule with evidence supporting a local recurrence. No scanning evidence of metastatic disease. I’m starting EBRT tomorrow on the nodule and pelvic lymph nodes.

Anyway, has anyone done a digital rectal exam? If something is found, that would likely put you in the fast lane for a PET scan.

Ten+ years until recurrence, and very low PSA doubling time are in your favor for slow disease progression, if you do have a recurrence. I would push to get a PET scan. If they can pinpoint the recurrence, then any radiation treatment will be more of a precision strike.

There are studies that have indicated that early salvage radiation (before PSA is 0.2) yields better outcomes. But with that said, I like you, have been concerned about over treatment for recurrence. With my PSA being low, I allowed myself the time to weigh all the risks and benefits of immediate vs delayed salvage therapy, and different treatment options. I feel that I am making the right choice to move forward with radiation therapy now.

Best wishes. The sub 0.2 PSA without scanning or digital evidence of a recurrence is a bit of a gray zone.