title: EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013.
abstract: BACKGROUND
  The most recent summary of the European Association of Urology (EAU) guidelines on prostate cancer (PCa) was published in 2011.
  
  
  OBJECTIVE
  To present a summary of the 2013 version of the EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined PCa.
  
  
  METHODS
  A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group. The guidelines have been updated, and levels of evidence and grades of recommendation have been added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews.
  
  
  RESULTS
  A full version of the guidelines is available at the EAU office or online (www.uroweb.org). Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa. Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method. Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy. A biopsy progression indicates the need for active intervention, whereas the role of PSA doubling time is controversial. In men with locally advanced PCa for whom local therapy is not mandatory, watchful waiting (WW) is a treatment alternative to androgen-deprivation therapy (ADT), with equivalent oncologic efficacy. Active treatment is recommended mostly for patients with localized disease and a long life expectancy, with radical prostatectomy (RP) shown to be superior to WW in prospective randomized trials. Nerve-sparing RP is the approach of choice in organ-confined disease, while neoadjuvant ADT provides no improvement in outcome variables. Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa. For locally advanced disease, adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice. Follow-up after local therapy is largely based on PSA and a disease-specific history, with imaging indicated only when symptoms occur.
  
  
  CONCLUSIONS
  Knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice.
  
  
  RESULTS
  A summary is presented of the 2013 EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined prostate cancer (PCa). Screening continues to be done on an individual basis, in consultation with a physician. Diagnosis is by prostate biopsy. Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to androgen-deprivation therapy in locally advanced PCa not requiring immediate local treatment. Radical prostatectomy is the only surgical option. Radiation therapy can be external or delivered by way of prostate implants. Treatment follow-up is based on the PSA level.
authors.affiliation: Department of Urology, RWTH University Aachen, Aachen, Germany. Electronic address: aheidenreich@ukaachen.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.forename: Michel
authors.initials: M
authors.lastname: Bolla
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Theodor
authors.initials: T
authors.lastname: van der Kwast
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mason
authors.forename: Vsevolod
authors.initials: V
authors.lastname: Matveev
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.forename: F
authors.initials: F
authors.lastname: Zattoni
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
mesh_terms: D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment
keywords: Androgen deprivation; Diagnosis; EAU guidelines; Follow-up; Prostate cancer; Radiation therapy; Radical prostatectomy; Review; Treatment