Some things to consider:

You may want to go to the MSKCC and use their online tool to calculate PSADT and PSAV. This will give you a clinical data point on the aggressiveness of your PCa.

Next decision, imaging...the two approved by FDA are the C11 Choline and Aximun. There is also a variety of MRIs. The challenge there is at low PSA such as you have, they may not be able to identify where the recurrence is.

So, what to do..

If the PSADT is greater than 12 months your medical team may be right, wait until the next labs and see if there is any change in the progression that may indicate a change in the rate of the spread.

I understand that generally SRT has greater “success” of progression free survival and overall survival at lower PSA so you could pull the trigger now. If you make that decision then you have to decide what that treatment is...

Not so long ago and sometimes even today the medical community will say radiate the prostate bed only. More and more that option is falling out of clinical practice and being replaced by combined therapy that involves radiation to the prostate bed combined with short term, say six months of ADT. If you go with that combined regimen then you may want to talk with your medical team about including the PLNs, Mayo has data that shows more often than not BCR in your case is already in the PLNs and SRT to the prostate bed only does not work.

I know this because of my personal experience...surgery, BCR, failure of SRT, that was to the prostate bed only, aggressive PCa, GS8, rapid doubling and velocity times. When I finally had the C11 Choline scan at Mayo it showed the PCa was in four PLNs, fortunately no organs or bones. I finished a combined regimen of six cycles of taxotere, 18 months of Lupron and 25 radiation treatments in May 18. PSA has been undetectable since.

The jury is out but generally advanced PCa is considered as incurable. So, now you manage it as a chronic disease, treat, look for PFS, monitor, treat, repeat..,

Kevin