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 & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, metastatic hormone-sensitive and castration-resistant prostate cancer (PCa).
The Panel performed a literature review of new data, covering the time frame between 2023 and 2025. The Guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence.
Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. The range of treatment options for metastatic PCa has broadened, including androgen receptor pathway inhibitors (ARPI), metastasis-directed therapy, PARP inhibitors and their combinations, as well as PSMA-based therapy. The recommendations in the EAU Guidelines are based on clinical evidence and do not account for variations in cost, reimbursement structures, or resource availability across healthcare systems.
The evidence in the field of relapsing, metastatic, and castration-resistant PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management. A full version is available from the EAU Guidelines Office or online (http://uroweb.org/guideline/ prostate-cancer/).
European urology. 2026 Jul 15 [Epub ahead of print]
Derya Tilki, 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 Madsen, 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, Philip Cornford
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. 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; 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, 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, Bon Secours Hospital, Cork Ireland and University College Cork.