You ask...". I feel something needs to be done now or am I jumping the gun?"

There is not necessarily a "right" answer the forum can give you.

In part, clinical data can guide discussions with your medical team, PSADT, PSAV, GS, GG, pathology report. I think the further you get in this journey the less the latter "matter."

You don't say if you have had imaging to locate the site (s) of "activity." Results can certainly inform discussions with your medical team. At the PSA you describe PSMA imaging has statistically a roughly 2/3 chance of locating activity.

So, if not, discuss with your medical team.

I have criteria in conjunction with my medical team about clinical data that constitutes a decision to image.

MY criteria;

Three or more PSA tests spaced three months apart showing increases.

AND

PSA between .5-1.0

At that point we image and then discuss treatment choices.

You will have choices:

Do nothing until PSA reaches a level you and your medical team agree upon.

There are clinical trials that indicate with Oligometastatic disease MDT can push back the need for systemic therapy. There are others which point to combining short term systemic therapy with MDT to manage recurrence - https://www.urotoday.com/conference-highlights/astro-2025/astro-2025-prostate-cancer/163508-astro-2025-intermittent-adt-comprehensive-stereotactic-body-radiotherapy-for-hormone-sensitive-oligometastatic-prostate-cancer-crop-mature-results-of-a-prospective-trial.html?utm_source=newsletter_14672&utm_medium=email&utm_campaign=astro-2025-advancing-prostate-cancer-care-from-reducing-toxicities-to-milestones-in-metastatic-disease

You could skip imaging and just gp on systemic therapy. Your clinical data says there is activity. This is the "throw away" course of action for me, I want to know where it is and see what my radiologist can do. I do keep in mind that imaging won't show all activity, aka micro metastatic disease so short term systemic therapy is always in play for me.

At what level do you and your medical team decide to "act!?"

Again, follow the clinical data and discuss with your medical team. Were this BCR for the first time after surgery likely you "missed" the window to act...it's not...

Again, discuss with your medical team, what do they say? I have seen some say anywhere from 2-10!

Me, I am high risk, so somewhere between .5-1.0 is time to do something

Kevin