EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2026 Update. Part I: Screening, Diagnosis, and Local...

Area of Science:

• Urology
• Oncology
• Radiology
• Nuclear Medicine

Background:

• Clinically localised prostate cancer (PCa) management requires updated guidelines due to rapid evidence evolution.
• Multidisciplinary collaboration is essential for optimal PCa care.

Purpose of the Study:

• To summarize the 2026 European Association of Urology (EAU) and associated society guidelines for screening, diagnosis, and treatment of localised prostate cancer (PCa).

Main Methods:

• Literature review of new data published between May 2023 and 2025.
• Systematic evidence review to update guidelines and assign strength ratings to recommendations.

Main Results:

• A risk-adapted strategy for PCa screening, typically starting at age 50, is advised.
• Multiparametric MRI is recommended to reduce unnecessary biopsies; targeted and regional biopsies are preferred when indicated.
• Prostate-specific membrane antigen positron emission tomography (PSMA PET) is the most sensitive for detecting metastatic spread.
• Active surveillance is recommended for low-risk PCa and selected intermediate-risk cases.
• Hypofractionated radiotherapy and intensified hormonal treatment are recommended for specific intermediate-risk and node-positive (cN1) PCa stages, respectively.

Conclusions:

• The guidelines reflect the evolving landscape of localised prostate cancer (PCa) diagnosis and treatment.
• Updated recommendations support a multidisciplinary approach to PCa management.