Articles

EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Treatment of Clinically Localised Disease

By: Axel Heidenreicha lowast , Joaquim Bellmuntb, Michel Bollac, Steven Joniaud, Malcolm Masone, Vsevolod Matveevf, Nicolas Mottetg, Hans-Peter Schmidh, Theo van der Kwasti, Thomas Wiegelj and Filliberto Zattonik

Published online: 01 January 2011

Keywords: Prostate cancer, EAU guidelines, Review, Diagnosis, Treatment, Follow-up, Radical prostatectomy, Radiation therapy, Androgen deprivation

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Abstract

Objective

Our aim was to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the screening, diagnosis, and treatment of clinically localised cancer of the prostate (PCa).

Methods

The working panel performed a literature review of the new data emerging from 2007 to 2010. The guidelines were updated, and level of evidence and grade of recommendation were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews.

Results

A full version is available at the EAU office or Web site (www.uroweb.org). Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa. A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method. Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy. PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention. In men with locally advanced PCa in whom local therapy is not mandatory, watchful waiting (WW) is a treatment alternative to androgen-deprivation therapy (ADT) with equivalent oncologic efficacy. Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy (RP) shown to be superior to WW in a prospective randomised trial. Nerve-sparing RP represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk PCa, respectively. For locally advanced disease, adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice. Follow-up after local therapy is largely based on PSA, and a disease-specific history with imaging is indicated only when symptoms occur.

Conclusions

The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarise the most recent findings and put them into clinical practice.

Take Home Message

The current version of the European Association of Urology guidelines summarises the evidence-based recommendations on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa). Application of the guidelines in the counselling process will help improve the outcome of PCa patients.

Keywords: Prostate cancer, EAU guidelines, Review, Diagnosis, Treatment, Follow-up, Radical prostatectomy, Radiation therapy, Androgen deprivation.

Footnotes

a Department of Urology, RWTH University Aachen, Aachen, Germany

b Department of Medical Oncology, University Hospital Del Mar, Barcelona, Spain

c Department of Radiation Therapy, C.H.U. Grenoble, Grenoble, France

d Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium

e Department of Oncology and Palliative Medicine, Velindre Hospital, Cardiff, United Kingdom

f Department of Urology, Russian Academy of Medical Science, Cancer Research Centre, Moscow, Russia

g Department of Urology, Clinique Mutaliste de la Loire, Saint-Etienne, France

h Department of Urology, Kantonspital St. Gallen, St. Gallen, Switzerland

i Department of Pathology, University Health Network, Toronto, Canada

j Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany

k Department of Urology, University of Padua, Padua, Italy

lowast Corresponding author. Department of Urology, University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.