Moderate hypofractionation is safe and effective , but longer-term data are still lacking .
Brachytherapy represents an effective way to increase the delivered dose .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly localised prostate cancer ( PCa ) .
EVIDENCE SYNTHESIS BRCA2 mutations have been added as risk factors for early and aggressive disease .
Systematic screening is still not recommended .
An early prostate-specific antigen test , the use of a risk calculator , or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa .
Breaking the link between diagnosis and treatment may lower the overtreatment risk .
Multiparametric magnetic resonance imaging using st and ardised reporting can not replace systematic biopsy , but robustly nested within the diagnostic work-up , it has a key role in local staging .
In Northern and Western Europe , the number of men diagnosed with PCa has been on the rise .
Opportunistic testing versus organized prostate-specific antigen screening: outcome after 18 years in the Göteborg randomized population-based prostate cancer screening trial.
BACKGROUND It has been shown that organized screening decreases  prostate cancer ( PC ) mortality , but the effect of opportunistic screening is largely unknown . OBJECTIVE To compare the ability to reduce PC mortality and the risk of overdiagnosis between organized and opportunistic screening . DESIGN , SETTING , AND PARTICIPANTS The Göteborg screening study invited 10 000 r and omly selected men for prostate-specific antigen ( PSA ) testing every 2 yr since 1995 , with a prostate biopsy recommended for men with PSA ≥2.5 ng/ml . The control group of 10 000 men not invited has been exposed to a previously reported increased rate of opportunistic PSA testing . Both groups were followed until December 31 , 2012 . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Observed cumulative PC incidence and mortality rates in both groups were calculated using the actuarial method . Using historical data from 1990 - 1994 ( pre-PSA era ) , we calculated expected PC incidence and mortality rates in the absence of any PSA testing . The number needed to invite ( NNI ) and the number needed to diagnose ( NND ) were calculated by comparing the expected versus observed incidence and mortality rates . RESULTS AND LIMITATIONS At 18 yr , 1396 men were diagnosed with PC and 79 men died of PC in the screening group , compared to 962 and 122 , respectively , in the control group . In the screening group , the observed cumulative PC incidence/mortality was 16%/0.98 % compared to expected values of 6.8%/1.7 % . The corresponding values for the control group were 11%/1.5 % and 6.9%/1.7 % . Organized screening was associated with an absolute PC-specific mortality reduction of 0.72 % ( 95 % confidence interval [ CI ] 0.50 - 0.94 % ) and relative risk reduction of 42 % ( 95 % CI 28 - 54 % ) . There was an absolute reduction in PC deaths of 0.20 % ( 95 % CI -0.06 % to 0.47 % ) and a relative risk reduction of 12 % ( 95 % CI -5 to 26 % ) associated with opportunistic PSA testing . NNI and NND were 139 ( 95 % CI 107 - 200 ) and 13 for organized biennial screening and 493 ( 95 % CI 213- -1563 ) and 23 for opportunistic screening . The extent of opportunistic screening could not be measured ; incidence trends were used as a proxy . CONCLUSIONS Organized screening  reduces PC mortality but is associated with overdiagnosis . Opportunistic PSA testing had little if any effect on PC mortality and result ed in more overdiagnosis , with almost twice the number of men needed to be diagnosed to save one man from dying from PC compared to men offered an organized biennial screening program . PATIENT SUMMARY Prostate-specific antigen ( PSA ) screening within the framework of an organized program seems more effective than unorganized screening
Moderate hypofractionation is safe and effective , but longer-term data are still lacking .
Brachytherapy represents an effective way to increase the delivered dose .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly localised prostate cancer ( PCa ) .
EVIDENCE SYNTHESIS BRCA2 mutations have been added as risk factors for early and aggressive disease .
Systematic screening is still not recommended .
An early prostate-specific antigen test , the use of a risk calculator , or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa .
Breaking the link between diagnosis and treatment may lower the overtreatment risk .
Multiparametric magnetic resonance imaging using st and ardised reporting can not replace systematic biopsy , but robustly nested within the diagnostic work-up , it has a key role in local staging .
In Northern and Western Europe , the number of men diagnosed with PCa has been on the rise .