Non-EAU members can view the web versions. To become an EAU member, click here. The Prostate Cancer PCa Guidelines Panel have prepared this guidelines document to assist medical professionals in the evidence-based management of PCa. It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations die da prostata not necessarily result in the best outcome.
Guidelines are not mandates and do not purport to be a legal standard of die da prostata. The PCa Guidelines Panel consists of an international multidisciplinary group of urologists, radiation oncologists, medical oncologists, radiologists, a pathologist and a patient representative.
Fanti, Prof. O Rouvière die da prostata Dr. Henry, Prof. Mason and Prof. The PCa Guidelines Panel die da prostata acknowledges the assistance and general guidance provided by Prof.
Bolla, honorary member of the PCa Guidelines Panel. A quick reference document Pocket guidelines is available, both in print and as an app for iOS and Android devices. These are abridged versions which may require consultation together with the die da prostata text version. Several scientific publications are available [ 12 ] as are a number of translations of all die da prostata of die da prostata PCa Guidelines.
This document presents a full update of the PCa Guidelines publication. Die da prostata literature for the complete document has been assessed and updated, where relevant. Evidence summaries and recommendations have been amended throughout the current document and several new sections have been added. Systematic biopsy is an acceptable approach if mpMRI is unavailable.
Do not use mpMRI as an initial screening tool. Recommendations in biopsy-naïve patients. When mpMRI is positive i. When mpMRI is negative i. Recommendations in patients with prior negative biopsy. Use pre-biopsy mpMRI for die da prostata information.
Use individual life expectancy, health status, and comorbidity to guide PCa management. Recommendations in men on active surveillance. Perform multiparametric magnetic resonance imaging before a confirmatory prostate biopsy, if not die da prostata before the first biopsy. Perform multiparametric magnetic resonance imaging before a confirmatory biopsy, if not done before the first biopsy.
Do not offer ADT monotherapy to intermediate-risk asymptomatic men unable to receive any local treatment. Treat men with no evidence of metastatic disease with salvage radiotherapy and additional hormonal therapy. Prostate-specific antigen PSA recurrence after radical prostatectomy. Perform prostate multiparametric magnetic resonance imaging to localise abnormal areas and guide biopsies in patients fit for local salvage therapy.
Recommendations for biochemical recurrence after radical prostatectomy. Offer active surveillance and possibly delayed salvage die da prostata SRT to patients with biochemical recurrence and classified as EAU low-risk group at relapse who may die da prostata benefit from intervention. Do not offer hormonal therapy to every pN0 patient treated die da prostata SRT. Offer castration alone, with or without an anti-androgen, to patients unfit for, or unwilling to consider, castration combined with docetaxel or abiraterone die da prostata plus prednisone or prostate radiotherapy.
Advise men on androgen deprivation therapy to maintain a healthy weight and diet, to stop smoking and have yearly screening for diabetes and hypercholesterolemia. Supplementation with vitamin D and calcium is advised. Specific sections of the text have been updated based on SR questions prioritised by the Guidelines Panel. For the PCa Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature.
A broad and comprehensive literature search, covering all sections of the PCa Guidelines was performed. The die da prostata was limited to studies representing only high levels of evidence i. SRs with meta-analysis, randomised controlled trials RCTsand prospective comparative studies published in the English language.
After deduplication, a total of 1, unique records were identified, retrieved and screened for relevance. A total of new publications were added to the PCa Guidelines. A total of 1, new papers were identified and assessed. For each recommendation within the guidelines there is an accompanying online strength rating form, the basis of which is a modified GRADE methodology die da prostata 34 ].
These forms address a number of key elements namely:. These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence including certainty of estimatesand nature and variability of patient values and preferences. The strength rating forms will be available online.
Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1. The frequency of autopsy-detected PCa is roughly the same worldwide [ 10 ]. For men with relatives with PCa their age-specific increased risk of PCa can be estimated. The probability of high-risk PCa at age 65 was Prostate-specific antigen testing mainly inflates detection of, less relevant, any-risk PCa. Men with one first-degree relative diagnosed with PCa have a relative risk RR of 1.
Hereditary PCa is associated with a six to seven year earlier disease onset but the disease aggressiveness and clinical course does not seem to differ in other ways [ 1316 ]. Men of African descent show a higher incidence of PCa and generally have a more aggressive course of disease [ 17 ]. Specific ancestry-specific risk loci have been identified [ 18 ]. Of the underlying determinants of genomic diversity and mechanisms between genetic and environmental factors, much remains unknown. Die da prostata association studies have identified more than common susceptibility loci contributing to the risk for PCa die da prostata ].
Furthermore, among men with metastatic PCa, an incidence of Prostate cancer screening trials targeting BRCA mutation carriers are ongoing [ 25 ].
BRCA mutation carriers were reported to have worse outcome when compared to non-carriers die da prostata local therapy [ 26 ]. Japanese men have a lower PCa risk compared to men from the Western world. However, as Japanese men move from Japan to California, their risk of PCa increases, approaching that of American men, implying a role of environmental or dietary factors [ 28 ].
However, currently there are die da prostata effective preventative dietary or pharmacological interventions. On a population level, metformin die da prostata but not other oral hypoglycaemic agents were found to be at a decreased risk of PCa diagnosis compared with never-users adjusted OR: 0. A meta-analysis of fourteen large prospective studies did not show an association between blood total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels and the risk of either overall PCa or high-grade PCa [ 34 ].
The association between a wide variety of dietary factors and PCa have been studied Table 3. High alcohol intake, but also total abstention from alcohol die da prostata been associated with a higher risk of PCa and PCa-specific mortality [ 37 ].
A meta-analysis shows a dose-response relationship with PCa [ 38 ]. A weak correlation between high intake of protein from dairy products and the risk of PCa was found [ 39 ]. No association between intake of long-chain omega-3 poly-unsaturated fatty acids and PCa was found [ 40 ]. A relation between intake of fried foods and risk of PCa may exist [ 41 ]. A trend towards a favourable effect of tomato intake mainly cooked and lycopenes on PCa incidence has been identified in meta-analyses [ 4243 ].
Randomised controlled trials comparing lycopene with placebo did not identify a significant decrease die da prostata the incidence of PCa [ 44 die da prostata.
A meta-analysis did not show an association between red meat or processed meat consumption and PCa [ 45 ]. Phytoestrogen intake was significantly associated with die da prostata reduced risk of PCa in a meta-analysis [ 46 ]. Total soy food intake has been associated with reduced risk of PCa, but also with increased risk of advanced disease [ 4748 ].
A U-shaped association has been observed, with both low- and high vitamin-D concentrations being associated with an increased risk of PCa, and more strongly for high-grade disease [ 4950 die da prostata.
An inverse association of blood, but mainly nail selenium levels reflecting long-term exposure with aggressive PCa have been found [ 5152 ]. Selenium and Vitamin E supplementation were, however, found not to affect PCa incidence [ 53 ]. Hypogonadal men receiving testosterone supplements do not have an increased risk of PCa [ 57 ]. Balding was associated with a higher risk of PCa die da prostata [ 59 ]. Gonorrhoea was significantly associated with an increased incidence of PCa OR: 1.
Die da prostata exposure may also play a role, based on a meta-analysis which revealed that night-shift work is associated with an increased risk 2. Current cigarette smoking die da prostata associated with an increased risk of PCa death relative die da prostata [RR] 1. A meta-analysis on Cadmium Cd found a positive association magnitude of risk unknown due to heterogeneity between high Cd exposure and risk of PCa for occupational exposure, but not for non-occupational exposure, potentially due to higher Cd levels during occupational exposure [ 63 ].
Men positive for human papillomavirus may be at increased risk [ 64 ]. A number of die da prostata factors previously linked to an increased risk of PCa have been disproved including vasectomy [ 65 ] and self-reported acne [ 66 ]. There are conflicting data about the use of aspirin or non-steroidal anti-inflammatory drugs and the risk of PCa and mortality [ 67die da prostata ].
Ultraviolet radiation exposure decreased the risk of PCa hazard ratio [HR]: 0. A review found a small but protective association of circumcision status with PCa die da prostata 70 ]. However, the associations identified to date lack evidence for causality. As a consequence there is no data to suggest effective preventative strategies. Prostate cancer is a major health concern in men, with incidence mainly dependent on age.