Congratulations on your undetectable PSA numbers for two years!

I believe most insurance companies will cover treatments that are supported by established guidelines, such as those from the NCCN.

As for when to pull the trigger, however, I have heard different opinions from prominent oncologists. Some advocate acting at a relatively low PSA threshold, particularly for high-risk patients, because salvage radiation tends to be more effective when the amount of recurrent cancer is still very small.

Others take a more cautious approach. They argue that if PSA returns but remains relatively low—for example, around 0.2 to 0.5 ng/mL—there may be only a microscopic amount of cancer that cannot yet be seen on imaging. Their concern is that radiation to a broad area, such as the prostate bed and/or pelvic lymph nodes, can cause significant side effects, including worsening urinary incontinence and bowel problems. From this perspective, treating too early, without knowing exactly where the cancer is, could cause permanent harm without necessarily guaranteeing a cure.

As you can imagine, both approaches have advantages and disadvantages. One emphasizes treating early, when the cancer burden is smallest and potentially most curable; the other emphasizes avoiding potentially unnecessary treatment and its side effects until there is stronger evidence of where the cancer is located. The appropriate choice can therefore depend on the individual’s pathology, genomic risk, PSA trend, and personal priorities.