Second Opinion????? Recurrence Post RALP

Hi all,

I’m looking for some perspective as I work through the next steps after prostatectomy.

**Brief background:**

* Age 67
* Radical prostatectomy: August 2025
* Pathology: Gleason 4+3 (Grade Group 3), ~80% pattern 4
* Cribriform and intraductal features present
* Extraprostatic extension (pT3a) and lymphovascular invasion
* Negative margins, lymph nodes negative
* PSA: 0.10 about 3 months ago → 0.17 this week

**Current situation:**
I’m being followed at a major center and have PET and MRI pending.

The main question I’m trying to think through is what to do **if imaging is negative**.

Specifically:

* Whether to proceed with **early salvage radiation** vs continued monitoring
* Whether to include **pelvic nodes vs prostate bed only**
* Role and duration of **ADT in this setting**

Given my pathology (cribriform/intraductal, LVI, etc.) and the PSA trend, I’m concerned about missing the optimal window for treatment if I wait too long, especially since I may be a lower PSA producer.

I did ask about genomic testing (Decipher) and was told it’s not necessary at this point.

After thinking this through, I realize I would be uncomfortable if the recommendation were to wait for something to declare itself on imaging. Because of that, I’m wondering whether I should start the process of getting a second opinion now, or wait until imaging results are back.

**My question:**
For those who have been in a similar situation (especially with higher-risk features but low PSA), how did your team approach:

* Timing of salvage radiation
* Field selection
* Use of ADT

Also—did anyone pursue a second opinion between major centers, and did that change your plan?

Appreciate any perspectives or experiences.