EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2026 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent
Abstract
BACKGROUND AND OBJECTIVE: To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa).
METHODS: The Panel performed a literature review of all new data published in English, covering the time frame between May 2023 and 2025. The Guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence.
KEY FINDINGS: A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. A new five-tier EAU classification has been introduced. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for patients with selected favourable intermediate-risk ISUP grade group 2 lesions. Local therapies are…
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