2. METHODS
2.1. Data identification
For the 2024 PCa Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A number of comprehensive searches were performd, covering all sections of the PCa Guidelines. The search was limited to English language publications. Databases searched included Medline, EMBASE and the Cochrane Libraries, covering a time frame between April 1st 2022 and May 1st 2023. A total of 3233 unique records were identified, retrieved and screened for relevance. A detailed search strategy is available online: https://uroweb.org/guidelines/prostate-cancer/publications-appendices.
Changes in recommendations were generally only considered on the basis of high-level evidence (i.e. systematic reviews (SR) with meta-analysis, randomised controlled trials (RCTs), and prospective comparative studies) published in the English language. Additional information can be found in the general Methodology section of this print and online at the EAU website: https://uroweb.org/guidelines/policies-and-methodological-documents/.
Recommendation within the Guidelines are developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:
- the overall quality of the evidence which exists for the recommendation [3];
- the magnitude of the effect (individual or combined effects);
- the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
- the balance between desirable and undesirable outcomes;
- the impact and certainty of patient values and preferences on the intervention.
Strong recommendations typically indicate a high degree of evidence quality and/or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [4]. The strength rating forms will be available online.
A list of Associations endorsing the EAU Guidelines can also be viewed online at the above address. In addition, the International Society of Geriatric Oncology (SIOG), the European Society for Radiotherapy & Oncology (ESTRO), the European Society for Urogenital Radiology (ESUR), the European Association of Nuclear Medicine (EANM) and the International Society of Urological Pathology (ISUP) have endorsed the PCa Guidelines.
2.2. Review
Publications ensuing from SRs have all been peer-reviewed.
2.3. Future goals
Results of ongoing and new SRs will be included in the 2025 update of the PCa Guidelines:
- A SR assessing the performance of risk stratification tools incorporating imaging, biomarkers, biopsy involvement and/or magnetic resonance imaging (MRI)-targeted biopsies, compared to the classical risk classifications (d’Amico, EAU, the Cancer of the Prostate Risk Assessment (CAPRA) and the National Comprehensive Cancer Network (NCCN)) recommended in current guidelines for predicting biochemical recurrence, metastasis or death after local treatment for prostate cancer. Are the new stratification tools preferred above the classical risk classifications?
- A SR assessing the outcomes of brachytherapy (BT) boost combined with external beam RT for PCa.
- Care pathways for the various stages of PCa management have been developed. These pathways will, in due time, inform treatment flowcharts and an interactive app.