Sorry to hear all this. I’ve been a somewhat of a similar journey and have some nuggets of experience worth sharing.

First, a question: You said that your husband’s PSA was undetectable on the first test following radiation therapy in May 2025. Was this a standard test where the lower limit of detection is 0.1? If so, the 0.11 result is barely above detection and could be due to lab variation. I would get a retest in that situation.

I was diagnosed with a local recurrence this past June. I had a RARP in 2015 (also Gleason 7) and went ten years with undetectable PSA. In June my PSA rose to 0.11 (Quest Labs). A few days later, I repeated the test because of the potential for lab variation. Second test yielded 0.12 (also Quest). A DRE revealed a small nodule in my prostate bed, so a PSMA PET scan was ordered, despite my low PSA.

The nodule lit up like a Christmas tree on the PET scan (SUV max of 13.3). Conventional wisdom in the medical community is that PSMA PET scans are very unlikely to show activity at PSA below 0.5. I completely defied those odds and to this date no medical doctor I’ve asked (PCP, urologist, oncologist) can explain the discrepancy between my low PSA and the intense PSMA PET scan results. Object lesson: don’t assume that a PSMA PET scan will come up blank at low PSA values.

Three months after my initial diagnosis, I retested my PSA days before starting 8 weeks of IMRT. The standard test at Quest once again came back at 011. I also did an ultra sensitive test at Labcorp on the same day (samples were collected about 20 minutes apart). That came back at 0.094—below detection for a standard test! But in essence, you could say my PSA was 0.1 and had not changed at all in 3 months.

I was quite concerned and surprised when my PSA registered 0.11 in June. My urologist was more dismissive initially but came around fast when the second PSA test a few days later came back at 0.12 and then the nodule was detected. At first he didn’t want to repeat the PSA test for another three months, so I went to my PCP who was absolutely proactive about a repeat test to rule out lab variance.. I would have been willing to pay OOP otherwise. That 0.11 result was just so barely over the limit of detection and within the range of lab variance. I don’t like making assumptions when there are ways to avoid doing that.

Anyway, test and retest, and don’t let conventional wisdom regarding PSA and PSMA PET scans keep your husband from getting that scan.

A lot of docs (and patients) seem to shy away from DREs these days. It was a DRE that ultimately lead to my diagnosis of a recurrence, not PSA. I’ve been poked and prodded so many times and in so many ways that I am way past any discomfort about that. A DRE ay well have saved my life this last time.

Best wishes going forward. This recurrence stuff is a whole different ballgame than the first go round. Keep us updated please.