How do you approach prostate cancer patients who present with retroperitoneal lymphadenopathy (stage M1a)?

Interesting question because I have had similar patients with differing amounts/extent of retrop-adenopathy and, as such, had to get a 'plan' in all cases:

1. For me, the easiest answer and first step is tissue confirmation of the adenopathy. That is, if tumor is the rumor, then tissue is the issue, because cancer may be the answer.

2. If it could be determined accurately, I would want to know how many + LN are on imaging because if it is 5 or less then one could get the patient involve one of the...