How do you approach rising PSA many years after prostatectomy with negative PSMA PET?

The devil is in the details.

What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help.

At what PSA value was the PSMA scan obtained? The utility of ...

I have felt slightly less comfortable using the finding of a negative PSMA PET/CT to omit pelvic lymph node coverage when administering post-operative radiotherapy. Based on the results of RTOG 0534, the inclusion of pelvic nodal irradiation has become the default for me given the benefit seen in th...

We have decades of experience making decisions about post-prostatectomy salvage radiation therapy in the setting of negative restaging scans. The data from that era informs us that the rPSA value declines >90% of the time with prostate bed-only XRT fields, even after a late relapse many years after ...

First off, the patient has biochemical recurrence, even if the PSMA scan is negative. At low PSAs, PSMA scans frequently do not show anything. Given what we know about treating at lower PSAs, we should still initiate salvage radiation at that time. Whether to include lymph nodes and/or ADT will depe...