For the 2026 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:

Review and changes to summary of evidence and recommendation in:

• Section 5.5.7: Recommendations for MRI imaging in biopsy indication and strategy.
• Section 5.8.5: Recommendations for staging of prostate cancer.
• Section 6.2.1.c: Summary of evidence and recommendations for active surveillance strategy.
• Section 6.4.4.d: Recommendations for imaging in patients with biochemical recurrence.
• Section 6.4.7: Recommendations for second-line therapy after treatment with curative intent.
• Section 6.6.8: Recommendations for the first-line treatment of hormone-sensitive metastatic disease.
• Section 6.7.13: Recommendations for systemic treatments of castrate-resistant disease.

Review and adaption of Table 4.3: EAU risk groups for localised and locally advanced PCa.

Addition of a new table: 

• Table 5.4: Available risk calculators assessing the risk of csPCa (externally validated five or more times).

Review and adaption of figures:

• Figure 5.1: Flow diagram to assist with decisions on prostate biopsy.
• Figure 6.5: Treatment of metastasized (M1*) – disease, M+HSPC.

Significant review and adaption of sections: 

• Section 5.2.4: Magnetic resonance imaging.
• Section 5.8.2.f.1: Pelvic lymph node dissection.
• Section 6.4.5.a.3: Salvage lymph node dissection.

Addition of new sections:

• Section 5.3.2.g: Rare aggressive PCa (sub)types.
• Section 5.4.3: Micro-US-based indication for biopsy.
• Section 5.5.6: MRI-targeted biopsy in younger men (45-55 years).
• Section 6.7.9: Treatment emergent neuroendocrine PCa and neuroendocrine subtype.

Addition of new subsections in Section 6.6.4.b.2: Androgen deprivation therapy combined with chemotherapy:

• Triplet therapy: ADT and chemotherapy +/- ARPI.
• ADT and ARPI +/- PARPI (AMPLITUDE).
• ADT and ARPI +/- AKT inhibitor (CAPItello-281).