@begreat99 From that scenario you sound like a candidate for adjuvant radiation /ADT and SBRT to the single pelvic lesion.
You probably have cells in your prostate bed and pelvic nodes so SBRT alone probably won’t solve the problem
Phil

@begreat99
The doctors I have experience with want to do salvage radiation when your PSA hits .2 after you have had surgery. That’s what happened to me 3 1/2 years after surgery I hit .2 and had salvage radiation. It worked for 2 1/2 years.

While your scan shows that there is a spot on the bone, they’re very likely smaller spots elsewhere that can’t be seen yet. That’s why they like to do salvage radiation in order to treat the prostate bed and the pelvic lymph nodes. The spots where it’s most likely to have growing metastasis that are too small to be seen.

You could have SBRT radiation on that bone mets, But since you are on Orgovyx Your PSA is probably too low to do a PSMA PET scan soon. And your PSA will probably go down to undetectable so you won’t be able to tell if that alone is the problem Based on your PSA.

Here’s some information about when you should have salvage radiation after surgery

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

@begreat99 It’s always difficult to know if they got it all. Each of us hopes that the bone/CT/MRI/PSMA PET scans see everything the first time; but that isn’t always the case. (My urologist/surgeon gave me a 50/50 chance of it being clean after surgery, but he could only be sure once he got in; that was a scary prognosis.)
It’s good that they’re now hitting yours hard with doublet therapy.