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, ...