My recent testing for a PCa relapse has yielded rather discrepant data regarding the aggressiveness of the recurrence.

I had a RARP in 2015. Pathology showed Geason 3+4 and a positive margin. My highest PSA before surgery was. 5.2.

For ten years post-RARP, my PSA was undetectable (< 0.1). In June 2025, my PSA rose to 0.11, and a DRE detected a small nodule in my prostate bed Conventional wisdom is that PSMA PET doesn’t detect PCa below a PSA of 0.2 (some docs say 0.5), but my urologist ordered one anyway (and insurance covered it).

Well, my PSMA PET scan flew in the face of that CW! Not only did the nodule light up, but it glowed with an SUVmax of 13.3. Some docs think that SUV intensity correlates directly with cancer aggressiveness, but I’ve yet to find any definitive studies for that.

Fortunately, the scan did not show evidence of distant mets, but then conventional wisdom would say that my PSA was too low for that. Confounding, to say the least.

I asked both my RO and urologist if they could reconcile the low PSA with the PSMA PET scan results. The short answer from both was “no”. But both agreed that I had local recurrence that needed treatment.

I’ve since gone through IMRT (38 sessions) to treat the recurrence. Now I wait until mid-February for a PSA test. No PSMA PET scan is planned unless my PSA is elevated.

Btw, in the three months from the PSA test of 0.11 to the start of RT, my PSA didn’t change. An ultra sensitive PSA test a couple days before starting RT came back at 0.094.

So, not exactly the same situation, but one piece of data (PSA) suggests low risk and the other (PSMA PET scan) suggests high risk. Big data discrepancy that defies the conventional wisdom about limits of detection on PSMA PET scans.

Only the future will tell which data are telling the real story.

Best wishes to you going forward.