PSMA PET/CT scan has found abnormal intense and intense uptakes in about ten lymph nodes in the pelvic area. My prostate initially treated in 2011 with brachytherapy for Gleason 3 + 3 cancer is now cancer free (no uptake) and 33 cc. The nodular mass attached to the capsule that was treated with cyber knife and ADT in 2016-2017 is not found on the scan.
My PSA is rising rapidly (0.2 on April 4, 3.26 on October 22) with PSADT less than two months. I have an appointment with a MO on November 16 and an appointment with a team of MO, RO, and Uro on November 19. I don't know what timeline for treatment will be advised in these appointments. I seek opinion from the forum whether I should insist on treatment to start more or less immediately. Or should I wait for PSA value to rise beyond a threshold.
One of the lymph nodes that was 7 mm on the scan was found to be 15 mm x 9 mm in diameter during a biopsy on November 9 (required by NIH clinical study). I expect rest of the lymph nodes with abnormal intense and intense uptakes to be of similar dimensions by now.
Does earlier treatment give me a better prognosis?
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dac500
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I doubt they'll say that. I think you are rehearsing fantasies in your head that only cause anxiety rather than "preparing" you for anything. I practice mindfulness to keep me focussed in the present moment.
Burnett1948. On the 6/9/2018 I had a PSMA PET/CT scan that found a 13 x 9mm lymph node along the posterior margin of the right common iliac artery, most in keeping with a metastatic node. My Urologist referred me to a Radiation Oncologist and on this coming Friday the 16/11/2018 I will have finished 25 shots of radiation. The scan said there are incidental findings and said that PSMA activity throughout the remainder of the abdomen and pelvis are too small to further characterise but appear unchanged from my 12 January 2015 PSMA/CT scan. I wonder where the lymph node came from? But after the first week of radiation I spoke to the Radiation Oncologist. I asking her this question. She said that there isn't a scanning machine in the world that can pick up prostate cancer under a half a centimeter: that's under 5 mm. So if I was you I would get treated as soon as you can. I know Tall_Allen has a lot more knowledge than me. I just hope that this current treatment is going to keep my prostate cancer quite for a while.
Early intervention is very important. The situation almost always gets worse, without intervention. PCa requires continuous vigilance. I have 6 monthly PSA tests after having had Proton Beam Therapy in 2013 in Korea. PSA still dropping but is now almost zero. My brother with mCRPC had PSMA Lu-117 therapy 18 months ago. All clear for 15 months, then it came flooding back.
Many treatment options now presenting themselves, with more to come over the next few years.
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Prostate cancer spread to pelvic and lymph nodes 
Radiate just the prostate when there is extensive lymph node involvement?
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