PET Scan or not yet?

You have to consider how quickly your PSA is rising if it’s doubling every couple of months then you might want to get treated sooner if it’s going up very slowly waiting for .2 makes a lot of sense.

It’s really too soon for a PET scan. PSA too low to really show anything.

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/

My doctor reminded me that PC grows slowly. They cant do radiation treatment until they have a target big enough to focus on.

@marlon

It grows slowly most of the time and for most of the patients but with high gleason or cribriform it can grow very fast and also metastasize even with low PSA .

Agreed that waiting makes sense until PSA goes higher but worry is they found it in lymph nodes removed
with surgery. Anyone out there have that as well and started radiation and ADT around .08-.1 ?

I agree with Jeff, depending of initial gleason and depending of doubling time you can possibly wait till it comes to 0.2 and than start with treatment but since you already had some nodes involved, I personally would not wait too long. I am not a doctor, of course, just talking from personal experience dealing with my husband's PC.

At PSA of 0.2 about 30% of scans would show something. If there is nothing seen, the official and standard protocol is to start RT anyways since all studies show that for prostate cancer patients experiencing biochemical recurrence, salvage radiotherapy (RT) combined with hormone therapy to the pelvic floor (prostate bed) and lymph nodes offers a 5-year progression-free survival rate of roughly 70% to 89%.

@magicbearcat1
One can definitely start RT earlier than 0.2 - there are many patients here that did that.

My husband wanted to do it at 0.1 but doubling time became so fast that with doctor's nonchalance he missed that window. He is now (was 2 weeks ago) 0.136 and will have PSMA this Thursday. Regardless of the scan he will start Orgovyx the same day and all prep for RT in about 2 mos.

I had two good PSA tests at 3 and 6 months post-op. Then in February it went to 0.2 and four weeks later to 0.3. They scheduled a PSMA PET-CT scan. They found it in my humerus bone of my right arm. I start radiation next week.

It's possible but I doubt a scan would be covered or approved by your insurance at your current PSA level but I'm not your Dr. so your urologist may be willing to push for it anyway.

Thanks for the responses. Much appreciated!

Get it done now. I am a retired Trauma Surgeon and had Cyberknife which cremated my Prostate. The PET scan is the gold standard

Watch Dr. Kwon’s latest PCRI video, particularly the discussion portion.