ALL SCANS CAME BACK NEGATIVE BUT PSA IS 2.3?

If it were me, and I was having no symptoms that may be related to PCA, I'd wait longer and see if the next PET scan can locate the source of the PCa. Taking radiation therapy when not knowing where the PCa is actually located, equates to shooting in the dark with the hope of zapping the bandit. There are definite side effects that will become apparent after radiation, if it were me, I would not want to incur those side effects, unless I was quite confident that they were radiating the area where they 'knew' that the PCa was located in.

I don't know what your current PCa medical team is comprised of, but if there is not a Medical Oncologist on your PCa medical team, I strongly recommend that you consider engaging one.

A Medical Oncologist has no professional preference for potential treatment options, such as surgery or radiation, and the Medical Oncologist is the expert in hormone therapies, which may be used in conjunction with other treatments, such as radiation. Personally, I've had PCa for over a decade, and my Medical Oncologist has been at my side for my entire PCa journey. Surgeons and Radiation Oncologists have come and gone with their treatments, at the direction of my Medical Oncologist, but my Medical Oncologist remains my sustaining medical professional and consultant.

You should tell us more precisely what kind of scans you got.

There's a relatively new PET scan (Pylarify) that seems to be good at finding hot spots at relatively low PSA levels. Its target is PSMA. In your shoes, I would insist on getting that one, even if you had to travel to get it.

PYLARIFY - Lantheus

Please post your PET report once you get it (without your name of course) and we can try to comment.

3 scans and NO PC found? 

Yes, that is awkward if we judge the last PSA in being correct. I wonder about the type of the cancerous cells found at your initial diagnosis of 2010. Can you tell us what was, at the time, the Gleason score, number of positive cores and PSA histology?

Regarding the state-of-art PET scan capabilities, these are subjected to the the type of isotope used to identify malignancy, timing of the picture session and location of the metastasis.

PSMA isotopes are the most appropriate for prostate cancer but the radio-tracer (F18, 68Ga, Lu177, etc) outcome differ on the location where the bandit is hiding. In my case (PSA 2.0 ng/ml), F18-Choline PET was positive identifying PCa at the prostate bed plus one deep lymph node of difficult access, but the 68Ga PSMA-PET was considered negative because the image at the prostate bed was blurred due to urine excretion (bladder filled with the tracer) and no lymph involved.

I believe that in localized recurrence cases the F18-PSMA radiopharmaceutical is the best choice. F18 has longer half-life allowing longer and timely sessions of picture taking which avoids the problem of tracer excretion via the bladder, and therefore the blurring seen in 68Ga-PSMA PET.

Though the PSA is high (if correct), I think you doing well in waiting for a more precise location of the bandit. Radiation works well at higher PSA levels but badly if the target is not the correct one.

I recommend you to repeat the PSA test every three months, adding a testosterone test in case you will require ADT in your future sequential therapy.

Best wishes,

VGama