BCR after RP inconsistent rise in PSA

According to Dr. Scholz at the latest PCRI conference
When PSA rises but can’t be found in the PSMA Pet scan, do an MRI, it will be found in Retroperitoneum or lung with high frequency.

If the cancer can’t be seen in a PSMA Pet scan then do an FDG scan or an Axumin scan, they can see tumors in those tests that cannot be seen by the PSMA Pet scan. This is recommended by a lot of doctors, Ask yours.

You Probably want to be on ADT soon, if you want to keep the cancer under control. It will stop whatever you have from growing further and will shrink it in most cases.

Having your PSA number jump around a little is not unusual.

PSA values and the associated doubling time can vary from in 3 month intervals for many reasons, even if the test is performed at the same lab, including location(s) of the cancer cells and any associated tumors.

Since your PSA was at the BCR point in May 2024, is there a reason why you chose not to have a secondary treatment (ADT) at that time?

As @jeffmarc stated, when a PSMA PET scan does not show tumors at your PSA level and rise time, other scan types are typically performed to determine the location of any tumors.

Even if tumors are not located, systematic treatment (ADT) can be used to limit spread of cancer cells until any decision is made on a secondary or salvage treatment.

My layman observation is that your PSA has doubled (or more) in 6 mos increments and your history suggests PCa cells in the prostate bed and pelvic lymph nodes.
18 mos ago, Salvage radiation together with a course of ADT reduced my PSA to undetectable < .02
My PSA was .19 postop with nothing definitive on the PSMA PET scan; G 9 w/ EPE, Stage 3ta, N0, X0
My sense is to treat what appears to be BCR as soon as practical.
Best wishes

Well,, others have offered solid advice so not sure I can add...

While imaging has and continues to advance, it is not perfect (see attached charts). discuss as others have said with your medical team other imaging - MRI, Axium..

As to the variations in the rate of PSA, lot of variables in testing , some may have to do with the assay used, the equipment, others may have to do with the variables you control , your pre-routine before the lab draw,

With that clinical data from the pathology report, somewhat surprised your medical team did not discuss adjuvant therapy, but that's history, question is what to do now.

Question is, will any future imaging change the treatment plan? If you and your medical team think so, and no financial toxicity (i.e. insurance) then you can try again with other imaging and go from there.

If imaging may not change the treatment decision, then you and your medical team can decide now. Options include doublet or triplet therapy, with or without radiation. The doublet could be ADT + AI, for a defined period, say 24-36 months. The triplet likely includes chemotherapy, Taxotere, usually six cycles spaced three weeks apart. Your medical team should include a radiologist who can discuss using it in a treatment decision. They have standard "templates" for the prostate bed and pelvic lymph nodes.

Kevin