@jamie1957 Our stories are not all that different. RARP when I was 62 (2015). Gleason 3+4. I was undetectable (<0.1) for ten years. Then in June 2025 my PSA hit 0.11. I also had a nodule in my prostate bed that lit up like Christmas tree on a PSMA PET scan, but no mets beyond that were detected. I did 38 sessions of salvage IMRT (both prostate bed and pelvic lymph nodes) last fall (Sept-Nov). I did an usPSA test just before starting therapy that yielded 0.097. The IMRT went pretty well with only a few hiccups, and I haven’t had any lingering serious side effects, so far. PSA really hasn’t dropped yet. As I stated in a previous comment, I’ve had four usPSA tests since RT and they average to 0.097, with min of 0.086 and max of 0.113. Not what I expected, but I’ve since learned that it can take 2-5 years for your PSA to bottom after RT. My RO and urologist are not oncerned at this point, so I will just continue with quaterly PSA test and see where it goes. My optimistic interpretation is that the cancer is indolent (ten years before recurrence supports that), and if so the cancer cells are not dying from radiation damage because they are not dividing much. Whether my interpretation is right or not, I took the path of early intervention, like you, aiming for a better outcome than if I waited to hit 0.2.

Anyway, best wishes to you going forward with your salvage RT. “Full bladder and empty rectum” will be your daily mantra for a while.

Mel