This 2026 update of the joint EAU–EANM–ESTRO–ESUR–ISUP–SIOG guidelines covers screening, diagnosis, and local curative-intent treatment of prostate cancer (PCa), based on a systematic literature review of evidence published between May 2023 and 2025.
Key updates include: (1) risk-adapted PSA screening starting at age 50 based on individualised life expectancy; (2) mpMRI recommended before biopsy to avoid unnecessary procedures; (3) combined targeted plus regional biopsy when biopsy is indicated; (4) a new five-tier EAU risk classification; (5) PSMA PET as the most sensitive staging tool for metastatic spread; (6) active surveillance endorsed for low-risk and selected favourable intermediate-risk (ISUP GG2) PCa; (7) hypofractionated radiotherapy recommended for intermediate-risk patients; and (8) radiotherapy plus long-term intensified hormonal therapy for cN1 disease.
Covers only localised/locally advanced PCa (Part I); evidence rapidly evolving, so some recommendations may have a short shelf life. Systematic review time frame (May 2023–2025) may exclude very recent data.
Use mpMRI before biopsy to reduce unnecessary procedures, and offer active surveillance to low-risk and selected favourable ISUP GG2 patients. For cN1 disease, combine radiotherapy to the primary tumour with long-term intensified hormonal therapy.
