I can't recommend enough that it is time for a medical oncologist who has a strong PCa background. In addition, a radiologist might be in a difference of opinion with your urologist. Your diagnosis warrants being proactive and leaving no stone unturned. Node involvement means usually that there will be no local cure, but there is still benefit to treating involved nodes with radiation. Even if a radiologist won't proceed on his judgement, there always one opinion that matters most. You are you own advocate and make all the calls. If you want to start HT and radiate, it's not your urologists call, it's yours. But don't do anything you don't understand what you are getting into with. QoL (quality of life) is the name of the game. Each step has side effects, but I have done well with them.
If HT fails, there are many things in reserve. But you really need that medical oncologist that specializes in systemic treatments. He should be well versed in when to act, and also every on every available clinical trial. I have taken these steps and it isn't too daunting at all.
Jim, I don't recall where you are. I am certain we can tell you where you can narrow your search to.
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1