Uroweb - European Association of Urology

1. INTRODUCTION

1.1. Aims and scope

The 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. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2. Panel composition

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

All imaging sections in the text have been developed jointly with the European Society of Urogenital Radiology (ESUR) and the European Association of Nuclear Medicine (EANM). Representatives of the ESUR and the EANM in the PCa Guidelines Panel are (in alphabetical order): Dr. A. Farolfi, Dr. D. Oprea-Lager, Prof.Dr. O. Rouvière and Dr. I.G. Schoots.

All radiotherapy (RT) sections have been developed jointly with the European Society for Radiotherapy & Oncology (ESTRO). Representatives of ESTRO in the PCa Guidelines Panel are (in alphabetical order): Prof.Dr. G. De Meerleer, Prof.Dr. A.M. Henry, and Prof.Dr. T. Wiegel.

The International Society of Urological Pathology is represented by Prof.Dr. A. van Leenders.

Dr. E. Briers, expert Patient Advocate Hasselt-Belgium representing the patient voice as delegated by the European Prostate Cancer Coalition/Europa UOMO.

All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website: https://uroweb.org/guidelines/prostate-cancer/panel.

1.3. Available publications

A quick reference document (Pocket guidelines) is available. This is an abridged version 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:
https://uroweb.org/guidelines/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 2024 document presents an update of the 2023 EAU-EANM-ESTRO-ESUR-ISUP-SIOG PCa Guidelines publication.

1.4.2. Summary of changes

The literature for the complete document has been assessed and all chapters of the 2024 PCa Guidelines have been updated. New data have been included in the following sections, resulting in new sections, and new and revised recommendations:

An update in section 4.4 regarding the 2016 Cambridge Prognostic Groups.
Restructure of section 5 – Diagnostic Evaluation to separate biopsy indication, biopsy strategy and biopsy approach.
Incorporation of new text and references throughout section 5 including a new subsection 5.3.4 on tissue samples for homologous recombination repair (HRR)-testing and 5.3.5.7 on Intra-operative assessment of surgical margin status. Update on Table 5.6, Table 5.7, Figure 5.2 and a new section in section 5.5.4 on perilesional biopsy.
New text additions throughout section 6 with special attention to section 6.1 treatment modalities and new summary of evidence in section 6.2.5 on active surveillance strategy as well as 6.4.2 on controversies in the definitions of clinically relevant PSA relapse. Substantial text additions to section 6.7.6.6 on combinations with PARP inhibitors
New recommendation in section 6.3.2.5 Guidelines for the treatment of intermediate-risk disease regarding active surveillance and radiotherapeutic treatment.
New recommendations in section 6.3.3.4 Guidelines for radical and palliative treatment of high-risk localised disease and for Pelvic lymph node dissection (PLND) and radiotherapeutic treatment
New recommendations in section 6.7.13 on the Guidelines for systemic treatments of castrate-resistant disease.
Small amendments to Figure 6.4 and Figure 6.5
New subsection 8.2.1 on active surveillance and 8.2.5.8 on osteonecrosis during bisfosfonates or denosumab as well as substantial addition of text to section 8.3.1 and 8.3.2