PET shows new activity 17 yrs after prostate surgery: What's next?

I am so sorry to hear that : (, I do not know enough to help with sound advice but I wanted to suggest that you should make separate new thread for your question as a "new topic" so everybody can clearly see it and help with answers.

Thanks surf. Will do 👍🏼👍🏼

Hey @longislandman - fellow islander from the North Fork here….I guess the simplest answer would be to do the minimum treatment that would keep you alive and not impact the quality of your life.
I would imagine that you would need a lot more info and testing from a medical or genito-urinary oncologist and NOT a surgeon or an RO - they are procedure driven.
There is an array of drugs available to keep your cancer under control - from simple hormonal suppression of testosterone to others which target other factors affecting cancer growth.
I am not well versed enough to give advice on these lesions - possible SBRT to the pelvis (bone?) but I think an 84 yr old should avoid major upsets to one’s life. Best,
Phil

@longislandman, as @surftohealth88 suggested, I pulled your comment and its replies into a discussion of its own. Whether to pursue further treatment or not is a personal choice. You and your oncologist can discuss treatment options and then weigh the pros and cons of each considering your personal factors like age, general health status, co-existing medical conditions if any, and, most importantly, your preference.

@longislandman, has it been confirmed that the acivity that the PET scans revealed in metastasis?

longislandman,
talk with a couple of radiation oncologists. Radiation itself is painless. And could preserve the quality in your life.

Input, but not qualified for wisdom.

Were the scans PSMA PET scans? Only to understand if you have certainty that both sites are most probably PCa metastases.

Assuming you have PSMA PET Scan data showing metastases ion those two sites, I am also making an assumption that the scan showed a lesion on bladder as opposed to an area of your body behind the bladder.

I would use the below data to make any treatment decisions based upon estimated quality of life versus time.

I would want to know from the best radiological center that you have access to what options they can offer for each site (pelvis and bladder), precision of the equipment the center can offer (others on this forum can provide you detailed feedback once they tell you the equipment they have), how they would mitigate damage to the bladder, and their assessment of potential complications for you.

Similarly from the genitourinary medical oncologist for ADT options. In particular, potential complications and side effects specifically for you.

Also from the genitourinary medical oncologist, their opinion based upon the information available to them of your specific PCa of time versus expected affects to both pelvis, bladder, and potentially other sites. Ideally, the oncologist has access to the PSA and PET Scan history to understand the rate of growths.

17 years is a long time and depending when your PSA reached 0.20 (BCR), and the doubling rate since, and when the first PET Scan detected growth on the pelvis and bladder, your oncologist can help you understand the affects to your pelvis and separately your bladder.

Hopefully others can give your more helpful input.