Familiarize yourself with terms like the staging system and systemic and micro-metastatic disease advanced prostate cancer.... Those help shape treatment decisions. The PET scan sees some, not all though, of the cancerous sites.

Discuss with your medical team - an oncologist, radiologist and urologist, but there are options.

It is possible for the urologist to remove the prostate, and those lymph nodes identified in the PET scan, your urologist can discuss that with you.

Systemic generally requires ADT for some defined period, some "forever" though those with lymph node only, not bone or organ involvement may be able to do intermittent, discuss with your oncologist (and urologist).

Micro-metastatic generally is associated with imaging, indicating too small to be seen by PSMA PET imaging, doesn't mean prostate cancer isn't there. Let's not get started on things like SUV Max, PSMA Avid...

Discuss with your radiologist whether or not they can treat say the prostate bed after surgery and the whole pelvic lymph node region.

An oncologist should also be consulted as you discuss doublet and triplet therapy which may include ADT, an ARI, Chemotherapy

https://connect.mayoclinic.org/member/00-153c33197d8a889a373320/ is saying the same thing as I am. Yours is advanced PCa, making treatment decisions more complex, required an integration of care between your medical team.

Start with understanding the staging system, here's one link - https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-stages

Then, familiarize yourself with guidelines such as the NCCN - https://www.nccn.org/patients/guidelines/content/pdf/prostate-advanced-patient.pdf

I say this so you can be an active participant in your treatment decisions and have sound discussions with your medical team. I have developed rules for myself and my medical team over these last 10+ years that have served me well. This is the one you may want to consider:

"I walk in the door ready to start the conversation at level. I don’t have to spend time talking about the basics, things like Gleason grade and clinical stage and what. I already know. I can have an intelligent discussion about the merits of a particular treatment for my cancer, my likelihood of, and risk of side effects."

Kevin