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

== Diagnosis and Evaluation ==

=== Imaging ===
* '''Indications'''
**'''Presence of high-risk features (≥cT3a, Grade Group 4/5, or PSA>20ng/mL)'''
*'''Modalities'''
**'''Bone scan'''
**'''Cross sectional imaging (CT or MRI)'''
*'''Timing'''
**'''At the time of diagnosis.'''

=== Tissue diagnosis ===

*'''Indications'''
**'''Suspicion of advanced prostate cancer and no prior histologic confirmation, when clinically feasible'''
***'''If the patient cannot tolerate biopsy or there is no accessible tissue, treatment may proceed in the absence of histological confirmation.'''
*'''Location'''
**'''From the primary tumor or site of metastases'''
***'''Biopsy of the metastatic deposit may be optimal;''' however, biopsy of the primary tumor may be all that is available.
*'''May guide management''', even though the clinical picture is often consistent with the diagnosis
** '''PARP inhibitors (olaparib, rucaparib) require the identification of mutations in DNA repair genes'''
** '''PD-1/PD-L1 inhibitors (pembrolizumab) require the identification of mutations in mismatch repair (MMR) gene defects leading to microsatellite instability.'''
** '''Biopsy may reveal evidence of neuroendocrine differentiation.'''