EURURO Vol. 71 No. 4

619 692

1. Introduction
The most recent summary of the European Association of
Urology (EAU) [8_TD$DIFF]Guidelines on prostate cancer (PCa) was
published in 2013 This update is based on structured
yearly literature reviews and systematic review through an
ongoing process. Evidence levels and grade of recommen-
dation have been inserted according to the general
principles of [9_TD$DIFF]evidence-based medicine .
PCa remains the most common cancer in men in Europe
(excluding skin cancer). Although the incidence of autopsy-
detected cancers is roughly the same in different parts of the
world, the incidence of clinically diagnosed PCa varies
widely and is highest in Northern and Western Europe
(>200 per 100 000 men/year) . This is suggested to be a
consequence of exogenous factors such as diet, chronic
inflammation, sexual behaviour, and low exposure to
ultraviolet radiation .
Metabolic syndrome has been linked with an increased
risk of PCa , but there is insufficient evidence to
recommend lifestyle changes or a modified diet to lower
this risk. In hypogonadal men, testosterone therapy is not
associated with an increased PCa risk . No drugs or food
supplements have been approved for PCa prevention.
Apart from age and African American origin, a family
history of PCa (both paternal and maternal ) are
well-established risk factors. If one first-degree relative
has PCa, the risk is at least doubled. It increases by 5–11
times when two or more first-line relatives are affected
. About 9% of men with PCa have truly hereditary
disease, which is associated with an onset 6–7 yr earlier
than spontaneous cases, but does not differ in other
ways. The only exception to this are carriers of the rare
BRCA2 germline abnormality, who seem to have an
increased risk of early-onset PCa with aggressive behav-
iour
2. Classification
The 2009 TNM classification for staging of PCa and the EAU
risk group classification are used ). The latter
classification is based on grouping patients with a similar
risk of biochemical recurrence after local treatment.
The International Society of Urological Pathology (ISUP)
2005 modified Gleason score (GS) is the recommended PCa
grading system. The biopsy GS consists of the Gleason grade
of the most extensive pattern plus the highest pattern,
regardless its extent. In radical prostatectomy (RP) speci-
mens, the GS is determined differently: A pattern compris-
ing 5% of the cancer volume is not incorporated in the GS,
but its proportion should be reported separately if it is grade
4 or 5.
Table 1 – EAU risk groups for biochemical recurrence of localised and locally advanced prostate Cancer
Low-risk Intermediate-risk High-risk
Definition
PSA < 10 ng/mL
and GS < 7
and cT1-2a
PSA 10–20 ng/mL
or GS 7
or cT2b
PSA > 20 ng/mL
or GS > 7
or cT2c
any PSA
any GS
cT3–4 or cN+
[3_TD$DIFF]Localised Localised Localised Locally advanced
GS = Gleason score; PSA = prostate-specific antigen.
sity-modulated technology is a key treatment modality with recent improvement in the
outcome based on increased doses as well as combination with hormonal treatment.
Moderate hypofractionation is safe and effective, but longer-term data are still lacking.
Brachytherapy represents an effective way to increase the delivered dose. Focal therapy
remains experimental while cryosurgery and HIFU are still lacking long-term convincing
results.
Conclusions: The knowledge in the field of diagnosis, staging, and treatment of localised
PCa is evolving rapidly. The 2016 EAU [5_TD$DIFF]-ESTRO-[6_TD$DIFF]SIOG Guidelines on PCa summarise the most
recent findings and advice for the use in clinical practice. These are the first[2_TD$DIFF] PCa guidelines
endorsed by the European Society for Radiotherapy and Oncology and the International
Society of Geriatric Oncology and reflect the multidisciplinary nature of PCa management. A
full version is available from the EAU office and online
).
Patient summary: The 2016 EAU-STRO-IOG Prostate Cancer (PCa) Guidelines present
updated information on the diagnosis, and treatment of clinically localised prostate cancer.
In Northern and Western Europe, the number of men diagnosed with PCa has been on the
rise. This may be due to an increase in opportunistic screening, but other factors may also be
involved (eg, diet, sexual behaviour, low exposure to ultraviolet radiation). We propose that
men who are potential candidates for screening should be engaged in a discussion with
their clinician (also involving their families and caregivers) so that an informed decision
may be made as part of an individualised risk-adapted approach.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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