Well, your medical team can discuss with you and by medical team I mean urologist, radiologist and oncologist.

When I had my C11 Choline scan at Mayo in Jan 17 my urologist and radiologist disagreed about one of the four "hot" sites being cancerous.

So, I made the decision based on my clinical data of high risk PCa, GS8, GG4, time to BCR and PSADT and PSAV to include it in the radiation treatment plan.

They agreed...

Given the clinical history you present, you have high risk PCa which may warrant aggressive therapy.

A urologist could do surgery to take out the lymph nodes, question to ask may be just that one or others too. When my urologist discussed this option with me, he was not a big fan, nor was I, in part because finding them in his experience was not as simple as one would think. That and with likelihood of micro-metastatic PCa elsewhere the likelihood that eradicating the PCa was dubious and either WPLN or SBRT may be a better treatment choice. That's why we say medical team, a radiologist should lead in that question of WPLN or SBRT, certainly the urologist and oncologist can chime in.

As to doublet therapy, an ADT agent such as Orgovyx has advantages over say Lupron:

Faster to castration
No flare
Lower CV side effect profile
Faster recovery of T

The side effects of no T are still in play either way.

Your medical team may add a 2nd agent such as an ARI.

How long would you be on those, your medical team can discuss, could be anywhere from 6-24 months.

If so, you and your medical team need to decide on decision criteria to come off treatment.

You could discuss doublet or triplet therapy. I am not sure chemotherapy is necessary at this point but discuss with your medical team.

Given you have advanced PCa and your clinical data, discuss with your medical team whether or not to do doublet therapy.

Whatever you decide it requires an integrated approach by your team, likely you will be the quarterback though!

Kevin