Advanced Prostate Cancer: AUA/SUO Guideline Amendment (2026) Part I: Evaluation and Treatment of Biochemically Recurrent (Following Exhaustion of Local Therapy) and Metastatic Hormone-Sensitive Prostate Cancer

PURPOSE: Following completion of the 2025 Update Literature Review (ULR), the American Urological Association (AUA) incorporated new evidence generated since the 2023 publication of this Guideline via the AUA Amendment process. The summary presented herein represents Part I of the two-part series dedicated to addressing updated recommendations to provide a clinical framework for the evaluation and management of biochemically recurrent (BCR) and metastatic hormone-sensitive prostate cancer (mHSPC). MATERIALS AND METHODS: The AUA/SUO Advanced Prostate Cancer Guideline was reviewed via the AUA ULR process, which identified 38 studies for full-text review that were published between March 16, 2022 and August 26, 2025. Relevant studies were incorporated into the Guideline evidence base, and Guideline statements were updated as appropriate. RESULTS: The Panel developed evidence- and consensus-based statements based on an updated review to provide guidance on evaluation and management of advanced prostate cancer. These updates are detailed herein. CONCLUSIONS: Part I of this Amendment provides updated guidance on imaging, germline and somatic testing, and evaluation and treatment of BCR following exhaustion of local therapy and mHSPC. This Guideline will require further review as the diagnostic and treatment options in this space continue to evolve.