Diagnosis and local treatment with curative intent

Objective: To present a summary of the 2016 version of the European Association of Urology (EAU) guidelines on screening, diagnosis, and local treatment with curative intent of clinically localised prostate cancer. Evidence acquisition: The Working Panel performed a literature review of the new data (2013-2015). The guidelines were updated and the levels of evidence and/or grades of recommendation were added based on a systematic review of the evidence Evidence synthesis: BRCA2 mutations have been added as risk factors for early and aggressive disease. In addition to the Gleason score the 5-tiered 2014 ISUP grading system should now be provided. Systematic screening s still not recommended. Instead, an individual risk adapted strategy following a detailed discussion and taking into account the patient’s wishes and life expectancy must be considered. An early PSA test, the use of a risk calculator or one of the promising biomarker tools are being investigated and might be able to limit the over-detection of insignificant PCa. Breaking the link between diagnosis and treatment may lower the over-treatment risk. A multiparametric MRI using standardis ed reporting cannot rule out systematic biopsy, but nested more robust within the diagnostic work-up, it has a key role in local staging. Active surveillance always needs to be discussed with very low-risk patients. The place of surgery in high-risk disease and the role of lymph node dissection have been clarified, as well as the management of node positive patients. Radiotherapy using dose-escalated intensity-modulated technology is a key treatment modality with recent improvement in outcome based on increased doses as well as combination with hormonal treatment. Moderate hypofractionation is safe, but long-term data are still lacking. High-dose-rate brachytherapy represents a interesting way to increase the delivered dose. Focal therapy remains experimental as convincing long term outcome results are still lacking, in particular for cryosurgery and high-intensity focused ultrasound. Conclusion: The knowledge in the field of diagnosis, staging and treatment of localis ed prostate cancer is rapidly evolving. The 2016 EAU guidelines on PCa summarise the most recent findings and provide recommendations for clinical practice. These are the first EAU