Operative Behandlung der Prostata-Erkrankungen
Non-EAU members can view the web versions. To become an EAU member, click Standards der Prostata. The Prostate Cancer PCa Guidelines Panel have prepared this guidelines Standards der Prostata 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 will not necessarily result in the best outcome. Guidelines are not mandates and Standards der Prostata 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 Standards der Prostata 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 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 mpMRI is unavailable. Do not Standards der Prostata mpMRI as an initial screening tool. When mpMRI is positive i. When mpMRI is negative i. Recommendations Standards der Prostata 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 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 Standards der Prostata radiotherapy SRT to patients Standards der Prostata 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 Standards der Prostata. 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 Standards der Prostata 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 Standards der Prostata SR questions prioritised by Standards der Prostata 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 Standards der Prostata 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 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 Standards der Prostata GRADE methodology [ 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 Standards der Prostata 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 Standards der Prostata 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.
Genome-wide association studies have identified more than common susceptibility loci contributing to the risk for PCa [ ]. Standards der Prostata, 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 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 dietary 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 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 Standards der Prostata. High alcohol intake, but also total abstention from alcohol has 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 Standards der Prostata acids and PCa was found [ 40 ].
Standards der Prostata 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 Standards der Prostata did not identify a significant decrease in the incidence of PCa [ 44 ]. 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 Standards der Prostata 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 Standards der Prostata increased risk of PCa, Standards der Prostata more strongly for high-grade disease [ 4950 ].
An inverse Standards der Prostata 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 Standards der Prostata a higher risk of PCa death [ 59 ]. Gonorrhoea was significantly associated with an increased Standards der Prostata 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 Standards der Prostata unknown due to heterogeneity between high Cd exposure and risk of PCa for occupational exposure, but Standards der Prostata 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 Standards der Prostata an increased risk of PCa Standards der Prostata been disproved including vasectomy [ Standards der Prostata ] and self-reported acne [ 66 ]. There are conflicting data about the use of aspirin or non-steroidal anti-inflammatory drugs and the Standards der Prostata 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 Standards der Prostata, 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.