The 2026 EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines update covers treatment of relapsing, metastatic hormone-sensitive, and castration-resistant prostate cancer (PCa), based on a systematic literature review of evidence published between 2023 and 2025.
Updated recommendations endorse risk-stratified salvage therapy for relapsing PCa and an expanded treatment toolkit for metastatic/castration-resistant disease — including ARPIs, PARP inhibitors and their combinations, metastasis-directed therapy, and PSMA-based therapy — each graded by strength of evidence.
Recommendations do not account for variations in cost, reimbursement, or resource availability across healthcare systems; the review window is limited to 2023–2025, so very recent data may be excluded.
Use risk stratification to guide salvage therapy after primary PCa treatment, and consider the expanded armamentarium — ARPIs, PARP inhibitors (alone or combined), and PSMA-targeted agents — when managing metastatic or castration-resistant disease. Always weigh local formulary access and reimbursement realities, as the guidelines do not factor these in.
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