The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines provide recommendations for the management of clinically localised prostate cancer (PCa). This paper aims to present a summary of the 2024 version of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on the screening, diagnosis, and treatment of clinically localised PCa.
The panel performed a literature review of all new data published in English, covering the time frame between May 2020 and 2023. The guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence.
A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for selected favourable intermediate-risk patients with International Society of Urological Pathology grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term intensified hormonal treatment.
The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa guidelines reflect the multidisciplinary nature of PCa management.
This article is the summary of the guidelines for "curable" prostate cancer. Prostate cancer is "found" through a multistep risk-based screening process. The objective is to find as many men as possible with a curable cancer. Prostate cancer is curable if it resides in the prostate; it is then classified into low-, intermediary-, and high-risk localised and locally advanced prostate cancer. These risk classes are the basis of the treatments. Low-risk prostate cancer is treated with "active surveillance", a treatment with excellent prognosis. For low-intermediary-risk active surveillance should also be discussed as an option. In other cases, active treatments, surgery, or radiation treatment should be discussed along with the potential side effects to allow shared decision-making.
European urology. 2024 Apr 12 [Epub ahead of print]
Philip Cornford, Roderick C N van den Bergh, Erik Briers, Thomas Van den Broeck, Oliver Brunckhorst, Julie Darraugh, Daniel Eberli, Gert De Meerleer, Maria De Santis, Andrea Farolfi, Giorgio Gandaglia, Silke Gillessen, Nikolaos Grivas, Ann M Henry, Michael Lardas, Geert J L H van Leenders, Matthew Liew, Estefania Linares Espinos, Jan Oldenburg, Inge M van Oort, Daniela E Oprea-Lager, Guillaume Ploussard, Matthew J Roberts, Olivier Rouvière, Ivo G Schoots, Natasha Schouten, Emma J Smith, Johan Stranne, Thomas Wiegel, Peter-Paul M Willemse, Derya Tilki
Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK. Electronic address: ., Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands., Hasselt, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Urology, King's College London, London, UK., European Association of Urology, Arnhem, The Netherlands., Department of Urology, University Hospital Zurich, Zurich, Switzerland., Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium., Department of Urology, Universitätsmedizin Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria., Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, USI, Lugano, Switzerland., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Urology, Metropolitan General Hospital, Athens, Greece., Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK., Department of Urology, University Hospital La Paz, Madrid, Spain., Akershus University Hospital (Ahus), Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway., Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands., Department of Urology, La Croix du Sud Hospital, Toulouse, France., Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia., Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon, France., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital-Västra Götaland, Gothenburg, Sweden., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.