They should be setting you up for salvage radiation. When they can’t find it, that is usually where it is located. Your urologist is not following the standard of care.

Here’s information from the America Society of clinical oncology that discusses what to do after your PSA rises following a prostatectomy

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/

thank you!

Consult with a Radiation Oncologist.

Salvage Radiation Treatment to whole pelvic floor and pelvic lymph nodes; WPRT

See SPPORT trial.

ADT - none or short term probably options; I would defer to RO.

I think that it is actually good news that you have gone 13+ yrs post-op with G 8.

May want to consider a Center of Excellence for consultation and creation/mapping of radiation treatment.

Best wishes.

@danchmo
Your situation and details are exactly the same as mine! Everything! After two negative PSMA scans I have chosen wait on treatment and so far my ultrasensitive PSA levels have gone up and down so I’m willing to wait rather than risk more permanent side effects of treatments. Good Luck to you!