Is it acceptable defer or forgo biopsy and to start androgen deprivation therapy in an elderly, fragile patient with PSA in the 900s and evidence of bone metastases?

These questions come up regularly in practice. There seem to be two questions here.

One is the acceptability of starting therapy for prostate cancer without biopsy confirmation. There is a small single institution retrospective evaluation and positive predictive value of PSA in diagnosing PCa. With a...