@tzach
Salvage radiation doesn’t usually affect sex life right away. That can take a few years before it stops working. I didn’t have any problems after salvage radiation, The incontinence didn’t start for six years. It doesn’t happen to everyone.

You need to take a look at your doubling rate, if the PSA is rising quickly, you need to treat it. Some people can stay at .2 for a year or two maybe move up to .3. And those cases you can hold off the radiation.

Here’s the recommendations from the American Society of clinical oncology for what to do after the 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/
I had salvage radiation 3 1/2 years after my prostatectomy when my PSA hit .2. They gave me an ADT shot two months before I had the radiation. If you get an ADT shot that will end your interest in having sex, Or at least diminished greatly. That does increase the chance that you will benefit from the radiation.

Some doctors believe that you can just hold off and keep doing PSMA Pet scans and wait until a metastasis shows up and zap it. That may or may not work for you. If someone gets a lot of metastasis that can become quite painful and be difficult to treat.