Editing AUA: Advanced Prostate Cancer (2023) (section)

==== Diagnosis and Evaluation ====

===== UrologySchool.com Summary =====

* '''<span style="color:#ff0000">History and Physical Exam'''
**'''<span style="color:#ff0000">Performance status'''
**'''<span style="color:#ff0000">Symptoms'''
* '''<span style="color:#ff0000">Labs (5):'''
*# '''<span style="color:#ff0000">PSA'''
*# '''<span style="color:#ff0000">Testosterone'''
*# '''<span style="color:#ff0000">LDH'''
*# '''<span style="color:#ff0000">Hemoglobin'''
*# '''<span style="color:#ff0000">Alkaline phosphatase'''
* '''<span style="color:#ff0000">Imaging'''
** '''<span style="color:#ff0000">Assess extent of metastatic disease (bone, lymph node, visceral)'''
* '''<span style="color:#ff0000">Other (1):'''
** '''<span style="color:#ff0000">Germline and somatic tumor genetic testing'''

===== History and Physical Exam =====
* '''Performance status and the extent of disease-related symptoms''' are strongly associated with mortality.

===== Labs =====
* '''PSA, testosterone, LDH, Hgb, alkaline phosphatase'''
* Laboratory risk-factors associated with increasing risk of mortality:
**Higher PSA
**Shorter PSADT
**Elevated LDH
**Testosterone <20-50ng/dL

===== Imaging =====
* '''Assess extent of metastatic disease (bone, lymph node, visceral)'''
** Increasing burden of metastatic disease in the form of the number of metastatic sites is associated with increasing risk of overall mortality.
** Visceral metastases are known to portend the highest risk of mortality, followed by bone, compared to lymph nodes
* '''Assess the extent of metastatic disease using conventional imaging at least annually or at intervals determined by lack of response to therapy.'''
** In patients with mCRPC treated with enzalutamide prior to chemotherapy in the PREVAIL trial, radiographic progression occurred in 24.5% of patients without PSA progression, suggesting that routine imaging can identify a significant portion of patients with radiographic progression who would otherwise not be identified.

===== Germline and somatic tumor genetic testing =====
* To identify DNA repair deficiency, microsatellite instability (MSI) status, tumor mutational burden, and other potential mutations that may inform prognosis and familial cancer risk, as well as direct potential targeted therapies.