Under what circumstances would you treat prostate cancer without a biopsy?

I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...

I have not treated definitively/curatively without biopsy. On occasion, I have treated painful bone mets with palliative RT in the setting of widespread metastatic disease and PSA in >1000.

In this case, would weigh the pros and cons with the patient - i.e. - we don't know if it is cancer, we don't...

I would proceed with treatment for obvious cases of metastatic disease in a patient who is too high risk for biopsy, e.g., a patient who cannot come off blood thinners, firm DRE, PSMA PET positive, markedly elevated PSA; treat as per guidelines for hormone-naive prostate cancer. I would hesitate to ...