To present a summary of the 2026 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 Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa).
The Panel performed a literature review of all new data published in English, covering the time frame between May 2023 and 2025. 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 to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. A new five-tier EAU classification has been introduced. 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 patients with selected favourable intermediate-risk ISUP grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionated radiotherapy in intermediate-risk patients is provided. Patients with cN1 PCa should be offered radiotherapy to the primary tumour 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.
European urology. 2026 Sep 01 [Epub ahead of print]
Philip Cornford, Roderick C N van den Bergh, Erik Briers, Peter Chiu, Daniel Eberli, Adina Epure, Andrea Farolfi, Valérie Fonteyne, Giorgio Gandaglia, Silke Gillessen, Nikolaos Grivas, Ann M Henry, Geert J L H van Leenders, Estefania Linares Espinos, Bo Matsen, Jan Oldenburg, Inge M van Oort, Daniela E Oprea-Lager, Matthew J Roberts, Olivier Rouvière, Ashwin Sachdeva, Maria De Santis, Ivo G Schoots, Emma J Smith, Johan Stranne, Thomas Wiegel, Derya Tilki
Department of Urology, Bon Secours Hospital, and University College Cork, Cork, Ireland. Electronic address: ., Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands., Europa Uomo, Antwerp, Belgium., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, University Hospital Zurich, Zurich, Switzerland., Department of Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, UFR Lyon-Est, Lyon France., Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Radiation Oncology, Ghent University, Ghent, Belgium., 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 and Faculty of Biomedical Sciences, USI, Lugano, Switzerland., Department of Urology, Lefkos Stavros-The Athens Clinic,Athens, Greece., Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK., Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Urology, University Hospital La Paz, Madrid, Spain., Department of Oncology, Akershus University Hospital (Ahus), Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway., Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands., 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., Division of Cancer Sciences, University of Manchester, Manchester, UK., Department of Urology, Universitätsmedizin Berlin, Berlin, Germany and Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., European Association of Urology, Arnhem, 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., 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, Türkiye.