Sorry to hear about your rising PSA. It is, I believe, time for you to gather some more info on the next steps. It’s my hope that with Gleason 9 and seminal vesicle invasion (SVI), your doctors have previously indicated that you are at higher risk of progressing and needing additional treatment. This is what it looks like to me, from my non-MD degreed perspective.
I have a free online link to a document which will help you get “grounded” in what most doctors will be thinking your “next steps” should be. The National Comprehensive Cancer Network (NCCN) publishes GUIDELINES for treatment of most cancer types and THIS link takes you to the Patient Guide for Prostate Cancer.
Lots of words in the front of the document, most of which you will already be familiar with, but then jump to the flowchart/”Treatment Pathways” starting on page 44. From what you described in this thread, your pathway starts on pg44, then jumps to pg47, then to pg49, then to pg51. You should map out your own pathway, and see if it follows the same steps that I just traced for you (you might have other information not included here that might lead elsewhere).
From pg51 (and pg52), we are talking about systemic treatment and controlling your testosterone in order to further control advancement of your cancer. Please do read the descriptions on pages 58-59.
Depending on how much you’ve already learned over the last several years of your PC journey, this could be repetitive, but I find that it is sometimes helpful to go back to “square one” when embarking down a new pathway. This GUIDELINE is the “patient version” of the same document that your doctors should also be following. You will need to find a medical oncologist next, so I would advise searching for one who specialized in the complexities of prostate cancer and don’t settle for a generalist.
I hope this helps you, and best wishes…