What treatment would you offer for a patient with prior primary prostate radiation, with a biochemical progression to PSA >1.0 and negative PSMA scan?  

I’m assuming the patient has already received a prostatectomy and received prostate bed radiation, with a rising PSA.  First, in terms of imaging, you may want to consider a contrasted pelvic MRI, which may reveal a small lesion in the prostate bed which may have been obscured by PET act...

Just to clarify - the patient had a localized prostate cancer (no history of prostatectomy), received definitive radiation, and now the PSA is > 1.0? And a PSMA PET/CT is negative. Based on the timeframe you are describing from end of prostate radiation, this could be a PSA bounce and not recurr...

ADT with salvage prostate fossa RT most likely including nodal region.