618 692
Guidelines
EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening,
Diagnosis, and Local Treatment with Curative Intent
Nicolas Mottet
a , * ,Joaquim Bellmunt
b , c ,Michel Bolla
d ,Erik Briers
e ,Marcus G. Cumberbatch
f ,Maria De Santis
g ,Nicola Fossati
h , i ,Tobias Gross
j ,Ann M. Henry
k ,Steven Joniau
l ,Thomas B. Lam
m , n ,Malcolm D. Mason
o ,Vsevolod B. Matveev
p ,Paul C. Moldovan
q ,Roderick C.N. van den Bergh
r ,Thomas Van den Broeck
l ,Henk G. van der Poel
s ,Theo H. van der Kwast
t ,Olivier Rouvie`re
q ,Ivo G. Schoots
u ,Thomas Wiegel
v ,Philip Cornford
wa
Department of Urology, University Hospital, St. Etienne, France;
b
Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA;
c
Harvard Medical
School, Boston, MA, USA;
d
Department of Radiation Therapy, CHU Grenoble, Grenoble, France;
e
Patient Advocate, Hasselt, Belgium;
f
Academic Urology Unit,
University of Sheffield, Sheffield, UK;
g
University of Warwick, Cancer Research Centre, Coventry, UK;
h
Unit of Urology/Division of Oncology, URI, IRCCS
Ospedale San Raffaele, Milan, Italy;
i
Universita` Vita-Salute San Raffaele, Milan, Italy;
j
Department of Urology, University of Bern, Inselspital, Bern,
Switzerland;
k
Leeds Cancer Centre, St. James’s University Hospital, Leeds, UK; University of Leeds, Leeds, UK;
l
Department of Urology, University Hospitals
Leuven, Leuven, Belgium;
m
Academic Urology Unit, University of Aberdeen, Aberdeen, UK;
n
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK;
o
Cardiff University, Velindre Hospital, Cardiff, UK;
p
N.N. Blokhin Cancer Research Center, Moscow, Russia;
q
Hospices Civils de Lyon, Radiology Department,
Edouard Herriot Hospital, Lyon, France;
r
Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands;
s
Department of Urology,
Netherlands Cancer Institute, Amsterdam, The Netherlands;
t
Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands;
u
Department
of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands;
v
Department of Radiation Oncology, University
Hospital Ulm, Ulm, Germany;
w
Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 6 1 8 – 6 2 9available at
www.scienced irect.comjournal homepage:
www.europeanurology.comArticle info
Article history:
Accepted August 2, 2016
Associate Editor:
James Catto
Keywords:
Prostate cancer
Localised
EAU
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-ESTRO-SIOG
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Guidelines
Screening
Diagnosis
Staging
Treatment
Radical prostatectomy
Radiation therapy
Androgen deprivation
Abstract
Objective:
To present a summary of the 2016 version of the European Association of
Urology (EAU) - European Society for Radiotherapy & Oncology (ESTRO) - International
Society of Geriatric Oncology (SIOG) Guidelines on screening, diagnosis, and local
treatment with curative intent of clinically localised prostate cancer (PCa).
Evidence acquisition:
The working panel performed a literature review of the new data
(2013–2015). The guidelines were updated and the levels of evidence and/or grades of
recommendation were added based on a systematic review of the evidence.
Evidence synthesis:
BRCA2
mutations have been added as risk factors for early and
aggressive disease. In addition to the Gleason score, the five-tier 2014 International
Society of Urological Pathology grading system should now be provided. Systematic
screening is still not recommended. Instead, an individual risk-adapted strategy follow-
ing a detailed discussion and taking into account the patient’s wishes and life expectancy
must be considered. An early prostate-specific antigen test, the use of a risk calculator, or
one of the promising biomarker tools are being investigated and might be able to limit
the overdetection of insignificant PCa. Breaking the link between diagnosis and treat-
ment may lower the overtreatment risk. Multiparametric magnetic resonance imaging
using standardised reporting cannot replace systematic biopsy, but
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robustly nested
within the diagnostic work-up, it has a key role in local staging. Active surveillance
always needs to be discussed with very low-risk patients. The place of surgery in high-
risk disease and the role of lymph node dissection have been clarified, as well as the
management of node-positive patients. Radiation therapy using dose-escalated inten-
* Corresponding author. Department of Urology, University Hospital, St. Etienne, France.
Tel. +33 477828331; Fax: +33 477517179.
E-mail address:
nicolas.mottet@chu-st-etienne.fr(N. Mottet).
http://dx.doi.org/10.1016/j.eururo.2016.08.0030302-2838/
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2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.