EAU GUIDELINES ON PROSTATE CANCER - PART 1: SCREENING, DIAGNOSIS, AND TREATMENT OF CLINICALLY LOCALISED DISEASE
Authors:
A. Heidenreich; J. Bellmunt; M. Bolla; S. Joniau; M. Mason; V. Matveev; N. Mottet; H. P. Schmid; T. Van Der Kwast; T. Wiegel; F. Zattoni
Published in:
Urol List 2011; 9(2): 83-94
Overview
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.
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