EAU guidelines on prostate cancer. Part I: screening, diagnosis, and treatment of clinically localised disease - Guía de la EAU sobre el cáncer de próstata. Parte I: cribado, diagnóstico y tratamiento del cáncer clínicamente localizado
2011
Objective: Our aim was to present a summary of the 2010 version of the European Association
of Urology (EAU) guidelines on the screening, diagnosis, and treatment of clinically localised
cancer of the prostate (PCa).
Methods: The working panel performed a literature review of the new data emerging from 2007
to 2010. The guidelines were updated, and level of evidence and grade of recommendation were
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 is available at the EAU office or Web site (www.uroweb.org). Current
evidence is insufficient to warrant widespread population-based screening by prostate-specific
antigen (PSA) for PCa. A systematic prostate biopsy under ultrasound guidance and local anaesthesia
is the preferred diagnostic method. Active surveillance represents a viable option in
men with low-risk PCa and a long life expectancy. PSA doubling time in < 3 yr or a biopsy
progression indicates the need for active intervention. In men with locally advanced PCa in
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
mostly recommended for patients with localised disease and a long life expectancy with radical
prostatectomy (RP) shown to be superior to WW in a prospective randomised trial. Nervesparing
RP represents the approach of choice in organ-confined disease; neoadjuvant androgen
deprivation demonstrates no improvement of outcome variables. Radiation therapy should be
performed with at least 74 Gy and 78 Gy in low-risk and intermediate/high-risk PCa, respectively.
For locally advanced disease, adjuvant ADT for 3 yr results in superior disease-specific
and overall survival rates and represents the treatment of choice. Follow-up after local therapy
is largely based on PSA, and a disease-specific history with imaging is indicated only when
symptoms occur.
Conclusions: The knowledge in the field of PCa is rapidly changing. These EAU guidelines on
PCa summarise the most recent findings and put them into clinical practice.
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