To present a summary of the 2020 version of 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 Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and local treatment of clinically localised prostate cancer (PCa).
The panel performed a literature review of new data, covering the time frame between 2016 and 2020. 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. Risk-adapted screening should be offered to men at increased risk from the age of 45 yr and to breast cancer susceptibility gene (BRCA) mutation carriers, who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 yr of age. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is performed, a combination of targeted and systematic biopsies must be offered. There is currently no place for the routine use of tissue-based biomarkers. Whilst prostate-specific membrane antigen positron emission tomography computed tomography is the most sensitive staging procedure, the lack of outcome benefit remains a major limitation. Active surveillance (AS) should always be discussed with low-risk patients, as well as with selected intermediate-risk patients with favourable International Society of Urological Pathology (ISUP) 2 lesions. Local therapies are addressed, as well as the AS journey and the management of persistent prostate-specific antigen after surgery. A strong recommendation to consider moderate hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term hormonal treatment.
The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for their use in clinical practice. These PCa guidelines reflect the multidisciplinary nature of PCa management.
Updated prostate cancer guidelines are presented, addressing screening, diagnosis, and local treatment with curative intent. These guidelines rely on the available scientific evidence, and new insights will need to be considered and included on a regular basis. In some cases, the supporting evidence for new treatment options is not yet strong enough to provide a recommendation, which is why continuous updating is important. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them.
European urology. 2020 Nov 07 [Epub ahead of print]
Nicolas Mottet, Roderick C N van den Bergh, Erik Briers, Thomas Van den Broeck, Marcus G Cumberbatch, Maria De Santis, Stefano Fanti, Nicola Fossati, Giorgio Gandaglia, Silke Gillessen, Nikos Grivas, Jeremy Grummet, Ann M Henry, Theodorus H van der Kwast, Thomas B Lam, Michael Lardas, Matthew Liew, Malcolm D Mason, Lisa Moris, Daniela E Oprea-Lager, Henk G van der Poel, Olivier Rouvière, Ivo G Schoots, Derya Tilki, Thomas Wiegel, Peter-Paul M Willemse, Philip Cornford
Department of Urology, University Hospital, St. Etienne, France. Electronic address: ., Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands., Hasselt, Belgium., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Academic Urology Unit, University of Sheffield, Sheffield, UK., Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy., Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy., Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Surgery, Central Clinical School, Monash University, Caulfield North, Victoria, Australia., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK., Department of Urology, Metropolitan General Hospital, Athens, Greece., Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK., Division of Cancer and Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU Medical Center, Amsterdam, The Netherlands., Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany., Department of Urology, Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands., Liverpool University Hospitals NHS Trust, Liverpool, UK.