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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 M. levator der Prostata not necessarily result in the best outcome. Guidelines are not mandates and do not purport to be a legal standard of care. 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. Henry, Prof. Mason and Prof. The PCa Guidelines Panel gratefully 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 M. levator der Prostata devices. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available [ 12 ] as are a number of translations of all versions of the PCa Guidelines.
This document presents a full update of the PCa Guidelines publication. The 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 M. levator der Prostata is unavailable. Do not use mpMRI as an initial screening tool. When mpMRI is positive i. When mpMRI is negative i. Recommendations in patients with prior negative biopsy. Use pre-biopsy mpMRI for staging 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 done before the first biopsy. Perform M. levator der Prostata magnetic resonance imaging before a confirmatory biopsy, if not done before the first biopsy.
Do not offer ADT monotherapy to intermediate-risk M. levator der Prostata 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 radiotherapy SRT to patients with biochemical recurrence and classified as EAU low-risk group at relapse who may not benefit from intervention.
Do not offer hormonal therapy to every pN0 patient treated with SRT. Offer castration alone, with or without an anti-androgen, to patients unfit for, or unwilling to consider, castration combined with docetaxel or abiraterone acetate 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 M. levator der Prostata 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 search 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 M. levator der Prostata 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 [ 34 ].
These forms address a number of key elements namely:. These key elements are the basis which panels M. levator der Prostata 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 [ M. levator der Prostata ]. For men with relatives with PCa their age-specific increased risk of PCa can be estimated. The probability of high-risk PCa at M. levator der Prostata 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 M. levator der Prostata the disease aggressiveness and clinical course does not seem to differ in other ways [ 13 M. levator der Prostata, 16 ].
Men of African descent show a higher M. levator der Prostata of PCa and generally have a M. levator der Prostata aggressive course of disease [ 17 ]. Specific ancestry-specific risk loci have been identified [ 18 ]. Of the underlying determinants of genomic diversity M.
levator der Prostata mechanisms between genetic and environmental factors, much remains unknown. Genome-wide association studies have identified more than common susceptibility loci contributing to the risk for PCa [ ]. Furthermore, among men with metastatic PCa, an incidence of Prostate cancer screening trials M. levator der Prostata BRCA mutation carriers are ongoing [ 25 ]. BRCA mutation carriers were reported to have worse outcome when compared to non-carriers after 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 M. levator der Prostata factors [ 28 ]. However, currently there are no effective preventative dietary or pharmacological interventions. On a population level, metformin users 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 M. levator der Prostata 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 M. levator der Prostata total abstention from alcohol has been associated with a higher risk of PCa and PCa-specific mortality [ 37 ]. A meta-analysis M. levator der Prostata 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 M. levator der Prostata comparing lycopene with placebo did not identify a significant decrease in the incidence of PCa [ M.
levator der 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 a 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 M. levator der Prostata risk of PCa, and more strongly for high-grade disease [ 4950 ]. 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 death [ 59 ]. Gonorrhoea was significantly associated with an increased incidence of PCa OR: 1. Occupational 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 was associated with an increased risk of PCa death relative risk [RR] 1. A meta-analysis on Cadmium Cd found a positive association magnitude of risk unknown due to heterogeneity between M.
levator der Prostata 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 other 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 [ 6768 ].
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 [ 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. Genetic factors are associated with risk of aggressive PCa but ongoing trials will need to define the clinical applicability of screening for genetic susceptibility to PCa.
Selenium or vitamin-E supplements have no beneficial effect in preventing PCa.