title: Early detection of prostate cancer: European Association of Urology recommendation.
abstract: BACKGROUND
  The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease.
  
  
  OBJECTIVE
  This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms.
  
  
  METHODS
  The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies.
  
  
  RESULTS
  The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40-45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥ 10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process.
  
  
  CONCLUSIONS
  A baseline serum PSA should be offered to all men 40-45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment.
authors.affiliation: Department of Urology, RWTH University Aachen, Aachen, Germany. aheidenreich@ukaachen.de
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Per-Anders
authors.initials: PA
authors.lastname: Abrahamsson
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: James
authors.initials: J
authors.lastname: Catto
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000592:standards*; D006801:Humans; D007610:Kallikreins / Q000032:analysis; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D019564:Unnecessary Procedures; D014572:Urology / Q000592:standards*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Advanced Prostate Cancer; Baseline PSA; EAU Guidelines; Metastasis; PSA; Prostate Cancer; Screening