@jeffmarc
Thats your choice, I don’t think I would radiate my pelvic area unless I know there is cancer to kill. There is a good possibility of damaging the bladder and colon. This is from Sloan Kettering:
“Radiation therapy can cause permanent urinary and bowel changes. Many people don’t notice any changes or have any symptoms. However, some people have late side effects.
Late side effects may be similar to the ones you had during treatment. There’s a very small chance you may develop other side effects. For example:
The opening of your bladder may become narrower.
You may lose your ability to control your bladder.
You may have blood in your urine.
You may have bleeding from your rectum.
Your rectum may be injured.
These side effects are rare. They may come and go over time or be persistent and chronic. Your healthcare team will help you manage them.” That’s great you did not have any long term problems but the radiation affects people differently. Just because you did not have any problems does not mean the next person will also not have any problems. Yes I am new to this site but have been on the American Cancer Society site for 11 yrs. I don’t know what you mean a large number will need extra radiation but on the ACS site many who posted that had surgery did not need extra radiation in the prostate bed. To each his own but 65% odds of the cancer not being there and let’s just radiate it anyway is iffy in my book. I will wait for it to show up in PET scan then spot radiate it. My body, my choice.

Dave 3+4

@jeffmarc Presumably Mayo's new trial will answer this specific question but I just see so many questions. Presumably everyone agrees that the SOC is to treat as early as possible for a biological recurrence after prostatectomy. Depending on definitions that would be at a .1 PSA which is then confirmed by a second PSA or just.2. The prevailing practice then is that it is best to treat at .25 or below and otherwise best if below .5. So what has changed? The only variable is that PET PSMA has become standard. And the entire question relates only to those that have biologically recurred but the Pet PSMA is negative. A very narrow cohort and question. Mayo is asserting correctly that we have many prostate cancers that biologically recurred after surgery but never metastasize. That also has been known. But now in the context of PSMA Pet they are having a trial to determine if we could avoid a lot of unnecessary treatment if we delay treatment and use PSMA to find the hotspot as PDA rises. This is where I get hung up. Obviously if PET PSMA had sensitivity where everything showed at .1 or .2 the trial would make perfect sense, but that simply isn't true. Both Surf's husband and I already see how fast PSA rises in some cases. So even intentionally pursuing treatment results in delayed treatment with fast doubling time cancer. What would our PSA's be at the time of treatment if we waited for positive imaging? How could that be beneficial given what we know about the importance of early treatment? I just see a lot of people like me that would easily blow past by .5 and up to 1 and then IF the psma imaging revealed the source(s) you would get treatment? Anyway, I know I am preaching to the choir it is just hard to see the underlying rational.