It seems in the last 4 months it has been rising more. Doctors are waiting until in gets to the standard 0.2 before starting radiation. I do understand why they need to wait as the PSA isn't high enough yet for the risk/reward of treatment.
BUT, those trials had inadequate samples of men with high risk pathology like you. Subsequent studies suggest that for men with Gleason 9 and stage T3, there is an advantage in doing salvage radiation ASAP. Maybe email them the following and then meet with them to discuss:
Almost same pathology and course here. Instead of following up with blind sRT, I elected gaining some time with adaptive Bicalutamide dosing. Just passed successfully the 2 year mark. Will see for how long it will go on working. Documenting my doings month by month in a thread entitled: "An engineer's Bicalutamide maneuvers".
I also had as close to same pathology as you that I’ve seen, except undetectable PSA post op and 4+3 held up.
However, I did have several saturated cores with 80% pattern 4.
I chose a very aggressive clinical trial of whole pelvic RT, abiraterone and 18 months ADT. I remain undetectable and drug free since the RALP in June of ‘19.
I wasn’t too enthusiastic about the ADT, no one is. But I knew what I needed to do to handle it well and did pretty easily.
I really like being drug free and having full return of testosterone for over 2 1/2 years now. We’ll see if it lasts, but I am prepared to the best of my ability to accept wherever I’m taken. .
PSMA scans weren’t available to me back then, they are to your advantage now. I would choose a different treatment path today if I had to do it all again but if I were you I would likely still try to nail it early. You have some seriously adverse features there, as did I.
thanks I am doing another test around January 20th and then my radiologist appointment on the 22nd. If it continues to rise I will try to talk them into early treatment.
Not sure about other areas but here they have protocols they have to adhere too. I’m just glad to have some doctors I can go to. You can wait up to 7 months to see doctors here.
First, PSADT doubling time has to be considered; yours is shorter than 15 months. Use this to your advantage to predict what's coming and act sooner than later.
Good luck. If I could go back I would have acted sooner and prevented this disease from progressing outside my prostate...that is key to a good outcome. Get the facts and act as soon as you think you need to. Rick
Despite a clean PET scan my PSA has been slowly rising too. I haven't been on ADT meds for six years. My urologist decided to put me on what I call 'ADT lite' -- finisteride. We'll see how that is working when I get my next PSA test in January.
"Finasteride, a specific and competitive inhibitor of 5α-reductase enzyme Type 2, inhibits the conversion of testosterone to dihydrotestosterone (DHT). In adults, DHT acts as primary androgen in prostate ..."
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PSA rising after clinical trail
Question, each month with rising PSA, when do I do a pet scan 
Advanced recurrent PCa, rising PSA, 2 negative PSMA PET Scans
Psa rising
Rise in PSA
