Follow up to lung mass

This is the man with the large LUL mass and the hot spot on the sacrum seen on PET. The main question was what to do and how to finish his staging. Our CT surgeon offered to do a mediastinoscopy for further staging (of a IIIA vs IIIB) to help decide on whether he would be operable. He had tumor invasion of the mediastinum itself (T4) with positive N2 nodes (IIIB). We are performing a MRI of the pelvis today to better define that hot spot (his PSA is high too) and a MRI of his head. Since he is not operable we feel inclined to further image but not biopsy the sacral lesion at this point. What do you think?