Sandbox

Sequence germline and tumor DNA Initiate androgen deprivation therapy • GnRH agonist or antagonist

Low-volume Disease

High-volume Disease Visceral metastasis or >4 bone lesions

Laboratory evaluations to determine etiology • Fasting blood glucose • Serum B12 with methylmalonic acid • Serum protein electrophoresis with immunofixation • Hemoglobin A1c with fasting glucose Common etiologies include: • Diabetes• Nutrition imbalance (eg, B12, copper, thiamine)• Alcohol use disorder• Medication toxicity• Monoclonal gammopathies• Hereditary

Refer to neuromuscular specialist • Laboratory testing for immune, inflammatory, infectious, or neoplastic etiologies. • Autonomic testing (eg, quantitative sudomotor axon reflex test, heart rate response to deep breathing, Valsalva maneuver, tilt table test) for those with prominent autonomic symptoms • Lumbar puncture, nerve imaging, and nerve biopsy may also be considered

Nerve conduction study (NCS) and electromyography (EMG) • Confirm presence of peripheral neuropathy • Exclude other etiologies (eg, lumbar radiculopathies, cervical myelopathy, compressive mononeuropathies) • Identify pathophysiology: 1.Axonal degeneration: suggested by reduced motor and sensory amplitudes on NCS and neurogenic motor unit potentials on EMG 2.Demyelination: suggested by slowed conduction velocities, prolonged distal latencies, and motor conduction block and temporal dispersion on NCS