@krs03
I had around eight weeks of salvage radiation. Had absolutely no side effects at all. Six years later I did start to have some incontinence issues, but I’ve had surgery and then radiation so either one of them could’ve caused it.

I would not fear salvage radiation. Yes, if they do it in 20 or so sessions, they use more radiation and that can cause some urinary issues, But they are almost always mild and most people have found Flomax resolves it. This problem doesn’t seem to be as common if they have 35 or more sessions.

Your PSA is too low to really start worrying. What is the doubling rate, is very important to figure out if you will need something done soon. They normally don’t do anything till your PSA hits .2.

@krs03 You tell ME!! When I saw him gloving up I said to myself ‘WTF?’ After he almost made me scream I asked him why he had to do that since I had no prostate. He said ‘Hey, you never know…’
That’s when I knew I had to get away from this guy since I knew about PSMA PET; he was still practicing as if the tip of his index finger was the most predictive tool in his arsenal.
It probably won’t happen to you.
Phil

@krs03 Your 7mm and 12mm lymph nodes are not one big cancer lesion. Those nodes went undetected by the PSMA PET scan because any cancer present in them had not created a single lesion in those nodes of at least 2mm in size. There were likely numerous very small lesions in those nodes.

@krs03 My post RARP pathology report revealed a positive margin, plus my Prolaris report gave a 53% chance of BCR at ten years, even though I was intermediate risk (3+4). So my urologist always performed a DRE along with every PSA test. My PSA was undetectable for ten years (< 0.1), then rose to 0.11 in June 2025. My new urologist at that point was unconcerned, and thought it was just lab variation. When he got my previous medical records, I pointed out to him that a DRE the year before (with my old urologist, who had retired) have detected a palpable nodule but that my PSA was still undetectable at the time, so no further action was taken. My new urologist did a 180 at that point and referred me to a colleague in his practice who was a specialist in advanced prostate cancer. Another DRE with that urologist re-confirmed the nodule and that it had not changed much, but I was immediately referred for a PSMA PET scan despite my low PSA. Insurance approved it because of the presence of the nodule and my risk factor for a BCR. The nodule lit up with an SUV max of 13 on the scan (odd given my low PSA) but that and a subsequent pelvic MRI affirmed a local recurrence (no evidence of mets beyond the prostate bed), which then led to salvage RT.

Basically, the DRE, and detection of the nodule, was the key procedure and data that put things in motion. Without that, my new urologist would have just seen me again in a year for a routine follow up, or maybe in 3 months if I pushed him on the 0.11 PSA value. Also, there was no need for a biopsy since the data from the DREs and then scans clearly established the local recurrence.

DREs never have bothered me much. I had two transrectal needle biopsies on my prostate way back when. Those were miserable and painful experiences.