@wert1234
You really need to get a PSMA Pet scan. Your PSA is so high that it should really light up what’s going on.
Your PSA should’ve become undetectable.
You are beyond even the high point where salvaged radiation would make sense. I’m gonna post the recommendations for salvage radiation after a prostatectomy just so you get an idea about what’s going on.
I’m one example, After my prostatectomy, my PSA did not rise for 3 1/2 years when it hit .2 my doctors gave me a Lupron shot and two months later I had salvage radiation. I can’t tell you how many people I know that I’ve had the exact same thing either less time or more time after the surgery. I’ve almost never hear about somebody having a PSA as high as yours after the surgery.
Here is that info on when to do salvage radiation after a prostatectomy. ASCO Is the American Society of clinical oncology.
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/
@jeffmarc I saw you had RARP & about 3.5 years later had BCR & SRT. Do you think or have read anything indicating BCR would have been prolonged or not at all if you had RT initially instead of RARP? I ask because RT gets prostate & surrounding tissue in case some adenocarcinoma has escaped.