Real Outlook?

Memorial Sloan Kettering Cancer Center in the US have a set of nomographs for predicting this sort of answer, based on their data.

Big warning here though. Do think very carefully if you actually want to know these predictions before you start. Don't do them out of idle curiosity. People often wished they hadn't done them afterwards, so think carefully about it first.

https://www.mskcc.org/nomograms/prostate

I think the question you are asking is "Risk of Dying of Prostate Cancer in Men With a Rising PSA After Radical Prostatectomy".

Another one might be the "Salvage Radiation Therapy" one. It gives you the chance of no recurrence in 6 years, which is not quite what you're asking.

The "Male Life Expectancy" one can be interesting too, how long you would have lived without any treatment. In theory, you can't to any worse than this even if you have been treated. (This is usually used to decide if it's worth treating someone at all who has other comorbidities they are likely to die from.)

Thanks all for taking the time to reply - the worrying numbers for me are that my psa never dropped to zero post-op ( about 10 weeks after it was 0.06). It then rose quite quickly to 0.24 around six months post OP. I have down hours of research and it seems that psa doubling time is the real litmus test of scale of the problem??
To me it feels like that outcome is quite binary i) if the disease is confined to the pelvic area then the salvage radiotherapy has given me a reasonable chance of cure ii) if there are micro mets that have not yet been seen then I’m on my way to the departure lounge.....

I always suggest men try to get a scan before starting salvage radiotherapy, and at your PSA level, that would need to be a newer PSMA PET scan. This is because some research showed 40% of people about to undergo blind salvage radiotherapy had their radiotherapy plan changed as a result of having a PET scan first, i.e. it found the mets somewhere the blind radiotherapy would not have treated.

One of my pet peeves is that patients don't get offered appropriate tests and treatments that their own treatment centre doesn't offer, so centres which don't have PSMA PET scans are less likely to use them to diagnose patients. Salvage radiotherapy is perhaps something you should consider being referred to one of the main cancer centres for, if your centre doesn't have the capability itself or offer to send you to get a PSMA PET scan somewhere else.

The scan might sometimes show radiotherapy won't be curative, in which case you can avoid the side effects for no benefit. It might alternatively show it's in the pelvic lymph nodes, at least some of which can be included in the treatment field, but are often not included in a plain prostate bed treatment.

It is also possible to get some hints of the location sometimes from the prostate histology, and from the pattern of PSA levels since the prostatectomy. Given you only get one shot at pelvic radiotherapy (at least to a first approximation), I think it's important to be sure it's hitting the correct target if at all possible.

Thanks for all the feedback - giving a bit more information I have actually 3 psma pet CT scans

1) pre the RP small focus of activity on 8th rib ( not present on subsequent scans?) March 19

2) after RP equivocal uptake 6th rib Oct 19

3) Feb 20 equivocal uptake seen in October no longer visible

the last two scans mention an area of subtle sclerotic change

does this throw any further light on the situation?