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 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 are Prof.Dr. O. Rouvière and Dr. I.G. Schoots and the EANM are Dr. A. Farolfi and Dr. D. Oprea-Lager. All radiotherapy (RT) sections have been developed jointly with the European Society for Radiotherapy & Oncology (ESTRO). Representatives of ESTRO are Prof.Dr. G. De Meerleer, Prof.Dr. A.M. Henry, and Prof.Dr. T. Wiegel. The International Society of Urological Pathology (ISUP) is represented by Prof.Dr. A. van Leenders. Dr. E. Briers represents the patient voice from the European Prostate Cancer Coalition and 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 Uroweb: https://uroweb.org/guideline/prostate-cancer/.

1.3. Available publications

A quick reference document, the Pocket guidelines, is available in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available, the latest dating to 2024 [1,2]. All documents can be accessed on the EAU website: http://uroweb.org/guideline/prostate-cancer/. An EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets and links to the extended guidelines.

1.4. Publication history and summary of changes

1.4.1. Publication history

The EAU PCa Guidelines were first published in 2001. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. This 2025 PCa Guidelines present a limited update of the 2024 publication.

1.4.2. Summary of changes

For the 2025 PCa Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include:

Addition of Table 3.1: Definition of familial and hereditary PCa.
Update of the EAU risk groups for biochemical recurrence of localised and locally-advanced PCa based on systematic biopsy. EAU intermediate-risk group has now been split into favourable and unfavourable.
Addition of Table 5.3: Sources of error in PSA value assessment
Significant update to section 5.4.2.4 – MRI in population-based screening protocols.
Adaption of the recommendation for transperineal biopsy in section 5.6.4.
Resturcture and update of section 5.5.2.6 Surigcal techniques for N-staging.
Updated recommendation for use of prostate-specific antigen-positron emission tomography/computed tomography for staging of intermediate-risk PCa (see section 5.8.5).
General reccomendations for management of PCa have been removed. All recommnedations are
now given per disease stage.
Section 6.6.4 – Combination therpies for management of metastatic PCa has been restructured.
New recommednation on use of darolutamide in section 6.6.8 - Recommendations for the first-line treatment of hormone-sensitive metastatic disease.
New recommendation on discussing all patients with hormone-sensitive metastatic disease in a multidisciplinary team in section 6.6.8 - Recommendations for the first-line treatment of hormone-sensitive metastatic disease.
New recommendation on offering bone protective agents to men on long-term androgen deprivation therapy plus/minus ARPI in the supportive care recommendations in section 6.6.9 related to hormone-sensitive metastatic disease.
New recommendation in section 7.4.6 for follow-up during hormonal treatment.
Expansion and update of section 8.2.5 – Androgen deprivation therapy with section 8 – Quality of life outcomes in PCa.

Not found