Unfortunately, it is not unusual for PSMA PET scan results to not detect tumors when the metastasis has not yet resulted in tumors large enough to be detected.

You can also consider getting a second opinion on the PSMA PET scan results, as this results interpretation is a unique skill.

Can you provide additional information on when you previously had ADT treatment and for how long? Any medication in addition to Lupron at the time? PSA results while on ADT?

It will be helpful if you can provide information on any previous germline (hereditary)) and/or somatic (tumor) testing results. If not previously done, I recommend considering. Others will provide you details on how to get germline testing done free.

ADT treatments have recently advanced both in terms of effectiveness and management of side effects. I expect that others will provide you current ADT recommended treatment details for Gleason 8 with BCR.

Everyone is different, but there are more options available now for managing PCa with a better quality of life.