TY - JOUR
T1 - EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1
T2 - Screening, Diagnosis, and Local Treatment with Curative Intent
AU - Mottet, Nicolas
AU - van den Bergh, Roderick C N
AU - Briers, Erik
AU - Van den Broeck, Thomas
AU - Cumberbatch, Marcus G
AU - De Santis, Maria
AU - Fanti, Stefano
AU - Fossati, Nicola
AU - Gandaglia, Giorgio
AU - Gillessen, Silke
AU - Grivas, Nikos
AU - Grummet, Jeremy
AU - Henry, Ann M
AU - van der Kwast, Theodorus H
AU - Lam, Thomas B
AU - Lardas, Michael
AU - Liew, Matthew
AU - Mason, Malcolm D
AU - Moris, Lisa
AU - Oprea-Lager, Daniela E
AU - van der Poel, Henk G
AU - Rouvière, Olivier
AU - Schoots, Ivo G
AU - Tilki, Derya
AU - Wiegel, Thomas
AU - Willemse, Peter-Paul M
AU - Cornford, Philip
N1 - Funding Information:
Financial disclosures: Nicolas Mottet certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Nicolas Mottet is a company consultant for Janssen, GE, BMS, Sanofi, Ipsen, AstraZeneca, Carrik, Arquer Diagnostics, Takeda, Bayer, and Astellas; has received speaker honoraria from Astellas, Pierre Fabre, Steba, Janssen, and Ferring; and has received fellowships and travel grants from Astellas, Ipsen, Sanofi, Janssen, and Roche. Erik Briers has received grant and research support from Ipsen, the European Association of Urology, and Bayer; is an ex officio board member for Europa UOMO; is an ethics committee and advisory group member for REQUITE; is a patient advisory board member for PAGMI; and is a member of SCA and EMA PCWP. Maria De Santis is a company consultant for Amgen, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Celgene, Dendreon, Eisai Inc., ESSA, Ferring, GSK, Incyte, Ipsen, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncologie, Roche, Sanofi Aventis, SeaGen, Shionogi, Synthon, Takeda, Teva, OncoGenex, and Sandoz; receives speaker honoraria from Amgen, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Ferring, GSK, Ipsen, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncologie, Roche, Sanofi Aventis, Synthon, and Takeda; participates in trials run by the Technical University Munich, Amgen, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Celgene, Dendreon, Eisai Inc., Ferring, GSK, Ipsen, Incyte, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncologie, Roche, Sanofi Aventis, SOTIO, and Cancer Research UK; participates in various trials as a member of the EORTC GU group; has received research grants from Pierre Fabre Oncologie; and has received travel grants from Amgen, Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Celgene, Dendreon, Ferring, GSK, Ipsen, Incyte, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncologie, Roche, Sanofi Aventis, SeaGen, Shionogi, Synthon, Takeda, and Teva/OncoGenex. Stefano Fanti is a company consultant for Bayer and ANMI; has received speaker honorarium from Bayer, Genzyme, ANMI, and GE Healthcare; and participates in trials by Amgen, Bayer, BMS, Genzyme, Janssen, Merck, and Novartis. Silke Gillessen is a company consultant for AAA International, Astellas Pharma, Bayer, Bristol-Myers Squibb, Clovis, CureVac, Ferring, Innocrin Pharmaceuticals, Janssen Cilag, MaxIVAX SA, Orion, Roche, Sanofi Aventis Group, Nectar, and ProteoMediX; received speaker honorarium from Janssen and Novartis; and participates in multiple trials from different companies. Jeremy P. Grummet received speaker honorarium from Mundipharma, a travel grant from Astellas, and a research grant from Cancer Australia; and is the owner of MRI PRO Pty Ltd., an online training platform. Ann M. Henry is a company consultant for Nucletron-Elektra; participates in trials by Cancer Research UK and the National Institute of Health Research (UK); received travel grants from the Medical Research Council, the National Institute of Health Research (UK), and Cancer Research UK; and received research grants from Cancer Research UK and the Sir John Fisher Foundation. Thomas B.L. Lam is a company consultant for, and has received company speaker honoraria from Pfizer, GSK, Astellas, and Ipsen. Malcolm D. Mason is a company consultant for Ellipses Pharma and Oncotherics. Derya Tilki received speaker honorarium from Astellas and a travel grant from Janssen. Henk G. van der Poel is a company consultant for Intuitive Surgical; has participated in trials for Astellas and Steba Biotech; and has received grant and research support from Astellas. Thomas Wiegel is an advisory board member for Ipsen; receives company speaker honoraria from Ipsen and Hexal; is a member of the Janssen Steering Committee; and has participated in the ATLAS/AUO trial. Philip Cornford is a company consultant for Astellas, Ipsen, and Ferring; received company speaker honoraria from Astellas, Janssen, Ipsen, and Pfizer; participated in trials run by Ferring; and received fellowships and travel grants from Astellas and Janssen. Roderick C.N. van den Bergh, Olivier Rouvière, Theodorus H. van Der Kwast, Thomas Van den Broeck, Marcus Cumberbatch, Nicola Fossati, Giorgio Gandaglia, Nikos Grivas, Michael Lardas, Matthew Liew, Lisa Moris, Daniela E. Oprea-Lager, Ivo G. Schoots, and Peter-Paul M. Willemse have nothing to declare.
Publisher Copyright:
© 2020
PY - 2021/2
Y1 - 2021/2
N2 - Objective: To present a summary of the 2020 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 Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and local treatment of clinically localised prostate cancer (PCa). Evidence acquisition: The panel performed a literature review of new data, covering the time frame between 2016 and 2020. The guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence. Evidence synthesis: 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. Risk-adapted screening should be offered to men at increased risk from the age of 45 yr and to breast cancer susceptibility gene (BRCA) mutation carriers, who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 yr of age. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is performed, a combination of targeted and systematic biopsies must be offered. There is currently no place for the routine use of tissue-based biomarkers. Whilst prostate-specific membrane antigen positron emission tomography computed tomography is the most sensitive staging procedure, the lack of outcome benefit remains a major limitation. Active surveillance (AS) should always be discussed with low-risk patients, as well as with selected intermediate-risk patients with favourable International Society of Urological Pathology (ISUP) 2 lesions. Local therapies are addressed, as well as the AS journey and the management of persistent prostate-specific antigen after surgery. A strong recommendation to consider moderate hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term hormonal treatment. Conclusions: The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for their use in clinical practice. These PCa guidelines reflect the multidisciplinary nature of PCa management. Patient summary: Updated prostate cancer guidelines are presented, addressing screening, diagnosis, and local treatment with curative intent. These guidelines rely on the available scientific evidence, and new insights will need to be considered and included on a regular basis. In some cases, the supporting evidence for new treatment options is not yet strong enough to provide a recommendation, which is why continuous updating is important. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them. The 2020 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 Geriatric Oncology (SIOG) guidelines on prostate cancer (PCa) summarise the most recent findings and provide recommendations for clinical practice, addressing screening, diagnosis, and local treatment with curative intent. Key stakeholders in PCa management were involved in their development, including a patient representative. A full version is available at the EAU office and online at http://uroweb.org/guideline/prostate-cancer/. A separate publication will address the management of relapsing-, metastatic-, and castration-resistant PCa.
AB - Objective: To present a summary of the 2020 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 Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and local treatment of clinically localised prostate cancer (PCa). Evidence acquisition: The panel performed a literature review of new data, covering the time frame between 2016 and 2020. The guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence. Evidence synthesis: 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. Risk-adapted screening should be offered to men at increased risk from the age of 45 yr and to breast cancer susceptibility gene (BRCA) mutation carriers, who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 yr of age. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is performed, a combination of targeted and systematic biopsies must be offered. There is currently no place for the routine use of tissue-based biomarkers. Whilst prostate-specific membrane antigen positron emission tomography computed tomography is the most sensitive staging procedure, the lack of outcome benefit remains a major limitation. Active surveillance (AS) should always be discussed with low-risk patients, as well as with selected intermediate-risk patients with favourable International Society of Urological Pathology (ISUP) 2 lesions. Local therapies are addressed, as well as the AS journey and the management of persistent prostate-specific antigen after surgery. A strong recommendation to consider moderate hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term hormonal treatment. Conclusions: The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for their use in clinical practice. These PCa guidelines reflect the multidisciplinary nature of PCa management. Patient summary: Updated prostate cancer guidelines are presented, addressing screening, diagnosis, and local treatment with curative intent. These guidelines rely on the available scientific evidence, and new insights will need to be considered and included on a regular basis. In some cases, the supporting evidence for new treatment options is not yet strong enough to provide a recommendation, which is why continuous updating is important. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them. The 2020 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 Geriatric Oncology (SIOG) guidelines on prostate cancer (PCa) summarise the most recent findings and provide recommendations for clinical practice, addressing screening, diagnosis, and local treatment with curative intent. Key stakeholders in PCa management were involved in their development, including a patient representative. A full version is available at the EAU office and online at http://uroweb.org/guideline/prostate-cancer/. A separate publication will address the management of relapsing-, metastatic-, and castration-resistant PCa.
KW - Active surveillance
KW - Androgen deprivation
KW - Diagnosis
KW - EAU-EANM-ESTRO-ESUR-SIOG guidelines
KW - Localised
KW - Prostate cancer
KW - Quality of life
KW - Radiation therapy
KW - Radical prostatectomy
KW - Screening
KW - Staging
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85095822867&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2020.09.042
DO - 10.1016/j.eururo.2020.09.042
M3 - Review article
C2 - 33172724
SN - 0302-2838
VL - 79
SP - 243
EP - 262
JO - European Urology
JF - European Urology
IS - 2
ER -