EAU–ESTRO–SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

TLDR: The 2016 EAU-STRO-IOG Prostate Cancer (PCa) Guidelines present updated information on the diagnosis, and treatment of clinically localised prostate cancer and reflect the multidisciplinary nature of PCa management.

About: This article is published in European Urology.The article was published on 2017-04-01 and is currently open access. It has received 2767 citations till now. The article focuses on the topics: Geriatric oncology & Evidence-based medicine.

Figures

Table 2: International Society of Urological Pathology 2014 grade groups*

Table 7: Definitions of active surveillance and watchful waiting

Table 4: Guidelines for screening and early detection

Table 6: Guidelines for staging of prostate cancer

Table 8: Summary of the main findings regarding treatment of non-metastatic PCa

Table 5: Indications for re-biopsy after a negative biopsy and the associated risk to find a prostate cancer

Frequently asked questions

Q1. What have the authors contributed in "Eau guidelines on prostate cancer. part 1: screening, diagnosis and local treatment with curative intent" ?

In addition to the Gleason score the 5-tiered 2014 ISUP grading system should now be provided. The 2016 EAU guidelines on PCa summarise the most recent findings and provide recommendations for clinical practice. An early PSA test, the use of a risk calculator or one of the promising biomarker tools are being investigated and might be able to limit the over-detection of insignificant PCa. 

Q2. What are the contraindications for a nerve-sparing approach?

High risk of extracapsular extension, such as locally advanced disease or any GS > 7 are usual contraindications for a nerve-sparing approach. 

Q3. What is the role of a multiparametric MRI in prostate cancer?

A multiparametric MRI using standardised reporting cannot rule out systematic biopsy, but nested more robust within the diagnostic work-up, it has a key role in local staging. 

Q4. What are the main reasons for the use of quinolones?

Oral or intravenous quinolones remain standard prophylactic antibiotics, in spite of the increasing resistance to quinolones, which is associated with a rise in severe and potentially lethal infectious complications [27]. 

Q5. What is the way to treat HFX?

HFX requires meticulous quality assurance, excellent image guidance and close attention to organ at risk dose-constraints to minimise the long term toxicity risk. 

Q6. How many cores should be taken from the peripheral gland?

Ten to twelve core biopsies should be taken from the peripheral gland, bilateral fromapex to base, as far posterior and lateral as possible. 

Q7. What are the common complications of a biopsy?

Other biopsy complications include haematospermia (37%), heamaturia lasting more than 1 day (14.5%), rectal bleeding lasting < 2 days (2.2%). 

Q8. What is the role of mpMRI in reclassifying PCa?

Rebiopsy to exclude Gleason sampling error is considered important, [41] and mpMRI combined with targeted prostate biopsy demonstrated additional value in reclassification to high-grade PCa [43]. 

Q9. What is the reason why patients should not be denied a RP?

Patients should not be denied this procedure on the grounds of age alone [21] provided they have at least 10 years of life expectancy and are aware that increasing age is linked to increased incontinence risk. 

Q10. How long is the interval for men at increased risk?

A 2-year interval for men at increased risk based on PSA level is reasonable, while it could be extended to up to 8-years for those not at risk. 

Q11. What is the method for detecting pT3a?

mpMRI may be helpful for selecting a nerve-sparing approach as it has good specificity (0.91 [95% CI: 0.88-0.93]) but low sensitivity (0.57 [95% CI: 0.49-0.64]) for detecting microscopic pT3a stages [46]. 

Q12. How many kallikreins are used to stratify prostate cancer risk?

Novel assays for risk stratification measuring a panel of kallikreins including the Prostate Health Index (PHI) test, and the four kallikrein (4K) score test are developed to reduce the number of unnecessary biopsies in men with a PSA between 2-10 ng/mL. 

Q13. What is the way to treat cN1 PCa?

In patients with cN1 PCa offer pelvic external irradiation in combination with immediate long-term ADT.2b BOffer adjuvant ADT for pN1 after ePLND. 

Q14. How many men are at increased risk of PCa metastasis?

In addition, men with a PSA > 1 ng/mL at 40 years and > 2 ng/mL at 60 years [18, 19] are at increased risk of PCa metastasis or death several decades later. 

Q15. What is the way to treat PCa?

High-intensity focused ultrasound of the prostate (HIFU) has been compared in asystematic review [86] to RP and EBRT as primary treatment for localised PCa. 

Q16. What is the main topic of the paper?

This paper summarises the new insights/many changes that have occurred in the screening, diagnosis and treatment of localised PCa over the last 3 years and is based on annual structured literature searches and systematic review as a continuous process.