PSA rising 4 years after DaVinci radictal prostatectomy, PSMA/PET shows nothing, what to do?

Hi , some similar stats to my own. I was refused a PSMA scan, but that was back in 2017. So I had the educated guess salvage RT. I started my SRT at just over 0.2, there was something in the prostate bed because the PSA went down. There was also something outside the prostate bed because the PSA didn't go down as much as expected and soon started to rise again. 

Years later following more PSA rises, PSMA scans showed activity in a pelvic lymph node,but didn't show any thing in the prostate bed.

Salvage RT did do some damage to my bladder but my level of damage is rare and there were numerous excursions into my bladder for other reasons. 

If you wait for the PSA to rise it means the cancer is growing. You may not have any cancer in the prostate bed. I had SABR treatment to two separate pelvic lymph nodes on two separate occasions. Further scans showed extensive spread and I started HT last year. 

Thanks Chris 

I had my RALP in November 2021. After 2 years my PSA rose to 0.2. My onco said that a PSMA scan may not show any spread at that level and so, starting September 2024, I had 33 sessions of EBRT to my prostate bed and pelvic lymph nodes followed by 12 month HT ( Decapeptyl). A broad brush approach to the most likely places.  My first very recent PSA test came out as undetectable but whilst that is a great result, I realise it is too early to be sure of success.

Peter