@ahanahan I know your anxiety all too well. I was pretty surprised when my PSA became detectable after ten years. If your rise is a recurrence, at least the 20 years is in your favor. Keep on top of it! Sounds like a PSMA PET scan might be in your future.

@ahanahan
You probably should be getting monthly tests now. It is recommended that you get salvage radiation at .2. Your PSA has risen a lot. You need to find out how quickly it’s doubling.

Here are the recommendations for what you should do from 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/