Management of prostate cancer: EAU guidelines on screening, diagnosis and local primary treatment

Abstract

The 2016 EAU-ESTRO-SIOG Prostate cancer guideline is based on systematic revues and follows a strict methodology. The main change regarding pathology is the 2014 ISUP grading system in five grades, on top of the Gleason core. An individual risk adapted strategy for early diagnosis following a detailed discussion on the pros and cons and taking into account the patient’s wishes and life expectancy must be considered. The use of risk calculator, or one of the promising biological tools regarding the biopsy decision, which remain based on PSA and DRE, will limit the overdetection risk. Cutting the link between diagnosis and treatment is a real possibility to lower the existing over-treatment. A multiparametric MRI is a key component of tumour staging but cannot be used to rule out biopsy or to limit the biopsy to the abnormal images. The experience of the reader is a key factor for staging efficacy. The place of surgery in high-risk lesions and the role of lymph node dissection have been clarified, as well as the management of node positive patients. Radiotherapy is a key treatment modality with recent improvement in the outcome based on increased doses as well as combination with hormonal treatment. Moderate hypofractionation has been shown to be effective, but long-term data are still lacking. All these improvements will lead to a better patient treatment and ultimately to a better outcome.