EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer—2026 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent
- Study type
- Clinical guideline
- Study name
- EAU-EANM-ESTRO-ESUR-ISUP-SIOG 2026
- Design
- Clinical guideline based on a systematic review of the evidence (European Association of Urology and partner societies)
- Source
- Eur Urol · 2026
In plain words
This European guideline says that PSA testing can be offered to well-informed men from age 50 (and earlier if there is a family history, African ancestry or a BRCA2 mutation); an MRI should be done before a biopsy; the biopsy should preferably be done through the perineum (the skin between the scrotum and anus) to lower the risk of infection; and for low-risk cancers, active surveillance is the standard treatment.
Key guideline recommendations
- Strong
Offer early PSA testing to well-informed men at elevated risk of prostate cancer: men from age 50; men from age 45 with a family history of prostate cancer before age 60; men of African descent from age 45; and BRCA2 mutation carriers from age 40.
- Weak
Offer an individualised, risk-adapted strategy for early detection to well-informed men with a life expectancy of at least 15 years.
- Strong
Stop early detection of prostate cancer based on life expectancy and performance status; men with a life expectancy of less than 15 years are unlikely to benefit.
- Strong
Perform MRI before biopsy in men with suspected organ-confined disease. Do not use MRI as an initial screening tool.
- Weak
When MRI is negative (PI-RADS ≤ 2) and clinical suspicion is low (PSA density below 0.20 and no family history), omit biopsy and offer PSA monitoring.
- Strong
Perform prostate biopsy by the transperineal route because of the lower risk of infectious complications and better antibiotic stewardship.
- Strong
In high-risk localised or locally advanced disease, perform metastatic work-up with PSMA PET/CT if available, or at least with cross-sectional abdominopelvic imaging and a bone scan.
- Strong
Offer active surveillance as the standard of care to all suitable patients (all low-risk patients and selected patients with favourable intermediate risk). Exclude patients with cribriform or intraductal histology on biopsy from active surveillance.
Study population
Men at risk of or with localised and locally advanced prostate cancer: screening and early detection, diagnosis, staging and treatment with curative intent.
Clinical significance and place in guidelines
The EAU guideline is the main urology reference in Europe and many other countries and is updated every year. The 2026 version emphasises an "MRI-first" pathway, transperineal biopsy, PSMA PET staging in high-risk disease and active surveillance for low-risk disease and selected patients with favourable intermediate risk, and introduces a new five-tier risk classification.
Limitations
Many recommendations rest on moderate- or low-quality evidence ("weak" grade). The text of the recommendations on this card is translated from the full 2026 guideline on the EAU website (uroweb.org; limited update March 2026), of which the Eur Urol paper is a summary.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.