The European Association of Urology (EAU) has released new guidelines for the management of prostate cancer.
The biggest change is that the association has revised the role of multiparametric MRI (mpMRI) in the diagnosis of prostate cancer. Key changes include the following:
- Do not use mpMRI as an initial screening tool.
- Adhere to Prostate Imaging Reporting and Data System (PI-RADS) guidelines for mpMRI acquisition and interpretation.
- In patients who have not had a biopsy, when mpMRI is positive (i.e., PI-RADS ≥ 3), combine targeted and systematic biopsy.
- In patients with prior negative biopsy, perform mpMRI before prostate biopsy.
- When mpMRI is negative (i.e., PI-RADS ≤ 2) and clinical suspicion of prostate cancer is high, perform systematic biopsy based on shared decision-making with the patient.
- Use individual life expectancy, health status, and comorbidity to guide prostate cancer management.
- For men in active surveillance, perform mpMRI before a confirmatory prostate biopsy, if it hasn't been done before the first biopsy.
- For external-beam radiation therapy (EBRT), use a total dose of 76 Gy to 78 Gy, or moderate hypofractionation (60 Gy/20 fractions in four weeks or 70 Gy/28 fractions in six weeks), in combination with short-term neoadjuvant plus concomitant androgen deprivation therapy (four to six months).
The guidelines were developed in collaboration with the European Association of Nuclear Medicine (EANM).
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