This article presents a summary of the 2025 Swedish prostate cancer guidelines, focusing on recurrence after local treatment, metastatic disease, and castration-resistant prostate cancer.
The 2025 Swedish guidelines introduce several important updates. Prostate specific membrane antigen (PSMA)-PET/CT is recommended only when PSA exceeds 0.2 µg/L, and reporting should follow the defined PSMA-RADS-scale. PSMA-PET/CT is preferred over lymph-node dissection for staging. A strong recommendation is issued for radiotherapy to the primary tumour in all oligometastatic men with a life expectancy > 5 years, whereas metastasis-directed therapy is restricted to clinical trials. Systemic treatment pathways now prioritise androgen receptor pathway inhibitors (ARPI) plus androgen deprivation therapy (ADT), with triple therapy (including docetaxel) used more selectively. Pathway-specific staging algorithms have been revised. The oly (ADP-ribose) polymerase inhibitor (PARPi) section has expanded, with broader genomic-based selection and integration into treatment sequencing. Two new chapters and an appendix address cardiovascular risk assessment before ARPI or chemotherapy. Supportive care is substantially strengthened. Compared with the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2025, the Swedish guidelines 2025 applies PSMA-PET/CT more conservatively, restricts PSMA-guided nodal salvage therapy, and issues a more universal recommendation for local radiotherapy in oligometastatic disease. The Swedish guidelines 2025 prioritise ARPI + ADT and limit triple therapy and PARPi combinations due to regulatory and reimbursement constraints. PARPi are largely reserved for BRCA1/2-mutated disease. The Swedish guidelines 2025 provide a more comprehensive framework for rehabilitation and survivorship.
The 2025 Swedish prostate cancer guidelines introduce multiple new recommendations and differ in several aspects from the European guidelines.
Scandinavian journal of urology. 2026 Apr 21*** epublish ***
Johan Stranne, Elin Axen, Ola Bratt, Stefan Carlsson, Jon Kindblom, Kimia Kohestani, Anna Kristiansen, Ingela Franck Lissbrant, Gabriel Moise, Elinor Nemlander, David Robinsson, Christian Torbrand, Elin Trägårdh, Jonas Wallström, Camilla Wennerberg, Camilla Thellenberg Karlsson
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. ., Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden; Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden., Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden., Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden., Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden., Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Radiotherapy, Ryhov County Hospital, Jönköping, Sweden., Department of Neurobiology, Care Sciences and Society; Liljeholmens Universitetsvårdcentral, Region Stockholm, Sweden., Department of Urology, Helsingborg Hospital, Helsingborg, Sweden., Department of Urology, Skåne University Hospital, Lund University, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden., Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden., Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden., Department of Health and Caring Sciences, Faculty of Health and Life Sciences. Linnaeus university, Kalmar Sweden; Department of Surgery, Region Kalmar County, Kalmar Sweden., Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden.