Hi steve0 and welcome to the site.
Sometimes side effects occur because healing isn't complete from the surgery. But for you, you've had two years to recover whatever erectile and urinary function you can. At this point, they're not going to get a whole lot better.
PSA doubling time (the amount of time it would take for PSA to double) is an indicator of how rapidly the cancer is progressing. A really short doubling time means that the cancer may be forming detectable metastases. We only know how to use doubling time as an indicator after the PSA reaches 0.1 ng/ml and there are 2 more readings after that. You were fortunate to use an ultrasensitive PSA test to catch this early, but no one knows how to use the doubling time to predict metastases when the numbers are that small. Instead, some are looking at PSA velocity
. In the following article, you can see that the researchers discovered that a PSA velocity of greater than 0.05 ng/ml/year indicated that the cancer was progressing. Low detectable PSA after prostatectomy – watch or treat?
Yours went from 0.086 to 0.132 in about
6 months, so your PSA velocity is about
0.09 ng/ml/yr and is well above that. The really important thing is to give you salvage radiation before the cancer metastasizes systemically to distant
locations where it will be incurable. Treating it now is likely to have much better outcomes than if you wait, as you can read in this article:Very early salvage radiation has up to 4-fold better outcomes and saves lives
One of the controversies is whether it is necessary to use hormone therapy along with salvage radiation. A clinical trial last year showed it was beneficial:Combining Androgen Deprivation Therapy (ADT) and Salvage Radiation Therapy (SRT) improves outcomes
Adequate radiation dose of at least 70 Gy is important. At this point, you may want to discuss all this with a radiation oncologist rather than a urologist.