The European Association of Urology (EAU) has issued updated guidelines on the screening, diagnosis, and treatment of clinically localized prostate cancer. The document also includes guidance about treatment of progressive and castration-resistant prostate cancer.
All 164 pages of the fully revised guidelines are already available on the EAU web site, and a summary article about the new guidelines has just been published in European Urology by Heidenreich et al.
In their summary article, Heidenreich et al. state that:
- Evidence is not currently sufficient to justify widespread population-based screening for prostate cancer using the PSA test.
- A systematic prostate biopsy under ultrasound guidance and local anesthesia is the appropriate method for the diagnosis of localized prostate cancer.
- Active surveillance is a viable method of management for men with low-risk prostate cancer and a long life expectancy.
- Watchful waiting is a viable treatment alternative to androgen deprivation therapy (ADT) with equivalent oncologic efficacy for men with locally advanced prostate cancer and for whom local therapy is not mandatory.
- Active treatment is mostly recommended for patients with localized prostate cancer and a long life expectancy.
- Radical prostatectomy has been shown to be superior to watchful waiting in a prospective, randomized trial.
- Nerve-sparing radical prostatectomy is the active treatment of choice in organ-confined disease.
- Neoadjuvant androgen deprivation in combination with radical prostatectomy has shown no significant benefit.
- Radiation therapy should be performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk patin ets with prostate cancer, respectively.
- For patients with locally advanced prostate cancer, adjuvant ADT for 3 years has superior disease-specific and overall survival rates and represents the treatment of choice.
- Patient follow-up after local therapy should be based on PSA data; a disease-specific history with imaging is indicated only if and when symptoms occur.
The new guideline classifies cryotherapy, high-intensity focused ultrasound (HIFU), and focal therapies under the heading “Experimental” as treatments for localized prostate cancer, which isn’t going to make some people happy. (Don’t shoot the messenger!)