Prostate Cancer

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

To access the pdfs & translations of individual guidelines, please log in as EAU member.
Non-EAU members can view the web versions.
To become an EAU member, click here.

N. Mottet (Chair), J. Bellmunt, E. Briers (Patient Representative), M. Bolla, P. Cornford (Vice-chair), M. De Santis, A. Henry, S. Joniau, T. Lam, M.D. Mason, V. Matveev, H. van der Poel, T.H. van der Kwast, O. Rouvière, T. Wiegel
Guidelines Associates: R.C.N. van den Bergh, T. van den Broeck, N.J. van Casteren, W. Everaerts, L. Marconi, P. Moldovan

1.INTRODUCTION

1.1.Aims and scope

The European Association of Urology (EAU) Prostate Cancer (PCa) Guidelines Panel have prepared this guidelines document to assist medical professionals in the evidence-based management of PCa.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account.

1.2.Panel composition

The PCa Guidelines Panel consists of an international multidisciplinary group of urologists, radiation oncologists, medical oncologists, a radiologist, a pathologist and a patient representative.

Section 6.3: Treatment - Definitive Radiotherapy, has been developed jointly with the European Society for Radiotherapy & Oncology (ESTRO). Representatives of ESTRO in the EAU PCa Guidelines Panel are (in alphabetical order): Prof.Dr. M. Bolla, Dr. A. Henry, Prof.Dr. M. Mason and Prof.Dr. T. Wiegel.

All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU Website Uroweb: http://uroweb.org/guideline/prostate-cancer/?type=panel.

1.2.1.Acknowledgement

The EAU PCa Guidelines Panel are most grateful for the support and considerable expertise provided by

Prof.Dr. J-P. Droz, Emeritus Professor of Medical Oncology (Lyon, France) on the topic of ‘Management of PCa in senior adults’. As a leading expert in this field, and prominent member of the International Society of Geriatric Oncology, his contribution has been invaluable.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available [1,2] as are a number of translations of all versions of the PCa Guidelines. All documents can be accessed on the EAU website: http://uroweb.org/guideline/prostate-cancer/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU PCa Guidelines were first published in 2001. This 2016 document presents a full update of the 2015 full text document.

1.4.2.Summary of changes

New and relevant evidence has been identified, collated and appraised through a structured assessment of the literature and incorporated in all chapters of the 2016 EAU PCa Guidelines.

Key changes for the 2016 print:

  • Chapter 4 - Classification and staging systems, the new 2014 International Society of Urological Pathology (ISUP) Consensus Conference findings have been included.
  • Section 5.2.4 Diagnosis - The role of imaging; the key findings of the systematic review on the performance of prostate pre-biopsy multi parametric MRI in predicting prostate biopsy results, have been included [3]. The recommendations have been adapted accordingly.
  • Section 6.2 - Radical prostatectomy, a new Section 6.2.6 - Indication and extent of pelvic lymph node dissection has been included.
  • Section 6.4 - Options other than surgery and radiotherapy for the primary treatment of localised PCa, has been revised and restructured.
  • Section 6.6 - Treatment: Metastatic PCa, has been completely revised.
  • Section 6.10 - Treatment of PSA-only recurrence after treatment with curative intent,

    Section 6.10.5.2 - Hormonal therapy; the key findings of a systematic review on ‘The role of hormonal treatment in PCa patients with non-metastatic disease recurrence after local curative treatment’ [4] have been included.

  • Section 6.10.11 - Salvage lymph node dissection has been included as a new topic.
  • Section 6.11 -Treatment: Castration-resistant PCa (CRPC), has been completely revised.

Changed recommendations and evidence summaries can be found in sections:

5.1.1 Guidelines for screening and early detection

Recommendation

LE

GR

Do not subject men to PSA testing without counselling on the potential risks and benefits.

3

B

PSA=prostate-specific antigen.

5.3.5Guidelines for staging of PCa

Intermediate-risk PCa

LE

GR

In predominantly Gleason pattern 4, metastatic screening, include at least a cross-sectional abdominopelvic imaging, and a CT/MRI and bone-scan for staging purposes.

2a

A*

In predominantly Gleason pattern 4, use prostate mpMRI for local staging and metastatic screening.

2b

A

High-risk localised PCa/ High-risk locally advanced PCa

LE

GR

Perform metastatic screening including at least cross-sectional abdominopelvic imaging and a bone-scan.

2a

A

mpMRI=multiparametric magnetic resonance imaging; CT=computed tomography.

6.4.5 Summary of evidence and guidelines for experimental therapeutic options to treat clinically localised PCa

Summary of evidence

LE

The available short-term data does not prove equivalence.

2b

There is no reliable long-term comparative data to indicate that CSAP or HIFU leads to equivalent oncological outcomes compared with radical prostatectomy or EBRT.

3

PSA nadir values after ablative therapies may have prognostic value.

3

Focal therapy of any sort appears promising but remains investigational, with uncertainties surrounding follow-up and re-treatment criteria.

3

Recommendation

LE

GR

Only offer cryotherapy and HIFU within a clinical trial setting.

3

B

HIFU=high-intensity focused ultrasound.

6.6.7Guidelines for hormonal treatment of metastatic prostate cancer

Recommendation

LE

GR

In newly diagnosed M1 patients, offer castration combined with docetaxel, provided patients are fit enough to receive chemotherapy.

1a

A

6.10.4.6Guidelines for imaging in patients with biochemical failure

PSA recurrence after RT

LE

GR

Choline PET/CT imaging is recommended to rule out lymph nodes or distant metastases in patients fit enough for curative salvage treatment

2b

B

PET/CT=positon emission tomography/computed tomography.

6.10.11.1Guidelines for salvage lymph node dissection

Recommendation

GR

Discuss salvage LND with men experiencing nodal recurrence after local treatment but it should be considered experimental and biochemical recurrence after salvage LND occurs in the majority of cases.

LND=lymph node dissection.

6.11.10 Summary of evidence and recommendation for life-prolonging treatments of mCRPC

Summary of evidence

LE

No clear-cut recommendation can be made for the most effective drug for secondary treatment (i.e. hormone therapy or chemotherapy) as no clear predictive factors exist.

3