With cancer in that many pelvic LNs, there is more than what was extracted. The question is, will adjuvant RT still do any good, or is it just a bunch of toxic radiation that won't make any difference?
To help answer that question, I think you should discuss getting the newly approved Axumin scan as soon as it makes sense to get a PSA test - say, 6 weeks from now. (Insurance probably won't approve the Axumin scan without evidence of recurrence - a PSA over 0.2, and they have to wait at least 6 weeks for the residual PSA from the surgery to clear your system, and they have to wait a few months for tissues to heal before adding radiation anyway).
Depending on what the Axumin scan shows, it will suggest two very different approaches - potentially curative, or long-term management of the disease. In the first case, a radiation oncologist will be the key doctor to meet with. In the second case, a medical oncologist will be the key doctor.
(1) If the Axumin scan shows only regional spread (pelvic LNs and prostate bed) and no distant spread, you can start on ADT+ adjuvant RT right away. ADT starts 2 months before the ART. There is some evidence that whole pelvic radiation may still be curative in some cases while the spread is still confined to the pelvic LNs./pcnrv.blogspot.com/2017/12/salvage-whole-pelvic-radiation-after.html
The lead author of that study was Karim Touijer at MSK. I recommend you talk to him. MSK has also done some very important work in escalating the radiation dose for salvage radiation, and in widening the treatment field.
(2) If the Axumin scan shows distant spread, you can start on an aggressive hormone therapy regimen of Firmagon + Zytiga + Prednisone. Early use has been found to greatly increase survival. You have your choice of several great medical oncologists in the area. At MSK, Michael Morris is excellent (or Philip Kantoff if he is still taking patients, possibly at Weill Cornell). At Yale, you have Dan Petrylak. At D/F, there's Christopher Sweeney. At Mass General, there's Mathew Smith.William Oh at Mt. Sinai; and Charles Drake at Columbia. You can't go wrong with any of them.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog