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If lymhnode involvement is suspected then radiation to the pelvic area is recommended. Since the Combidex scan is no longer available there is no reliable way to determine lymphnode involvement.
Simon,
You are in the highest risk category that surgeons will still work on. I would go with the open surgery asuming you've got a surgeon that has done at least 300 surgeries. Then you can still go onto hormone and radiation if they think you need it (they will). There is a good chance that the surgeon will find your situation worse once they open you up (tell them to take out your prostate no matter what they find). As my radiation oncologist said "waiting never improves your situation". I should have listened to her.
