When to Treat Lymph Node Metastatic Prostate Cancer

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?

Since the scans are clearly indicating activity, I think I’d be looking to get the treatment going.