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 .
A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy.
BACKGROUND Prostate biopsy guided by computer-assisted fusion of magnetic resonance imaging ( MRI ) and transrectal ultrasound ( TRUS ) images ( MRI group ) has not yet been compared with 12-core r and om biopsy ( RB ; control group ) in a r and omized controlled trial ( RCT ) . OBJECTIVE To compare the rate of detection of clinical ly significant prostate cancer ( csPCa ) between the two groups . DESIGN , SETTING , AND PARTICIPANTS This RCT included 175 biopsy-naïve patients with suspicion for prostate cancer , r and omized to an MRI group ( n=86 ) and a control group ( n=89 ) between September 2011 and June 2013 . INTERVENTION In the MRI group , two-core targeted biopsy ( TB ) guided by computer-assisted fusion of MRI/TRUS images of MRI-suspicious lesions was followed by 12-core RB . In the control group , both two-core TB for abnormal digital rectal examination ( DRE ) and /or TRUS-suspicious lesions and 12-core RB were performed . In patients with normal MRI or DRE/TRUS , only 12-core RB was performed . OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS The detection rates for any cancer and csPCa were compared between the two groups and between TB and RB . RESULTS AND LIMITATIONS Detection rates for any cancer ( MRI group 51/86 , 59 % ; control group 48/89 , 54 % ; p=0.4 ) and csPCa ( 38/86 , 44 % vs 44/89 , 49 % ; p=0.5 ) did not significantly differ between the groups . Detection of csPCa was comparable between two-core MRI/TRUS-TB ( 33/86 , 38 % ) and 12-core RB in the control group ( 44/89 , 49 % ; p=0.2 ) . In a subset analysis of patients with normal DRE , csPCa detection was similar between two-core MRI/TRUS-TB ( 14/66 , 21 % ) and 12-core RB in the control group ( 15/60 , 25 % ; p=0.7 ) . Among biopsy-proven csPCas in MRI group , 87 % ( 33/38 ) were detected by MRI/TRUS-TB . The definition of csPCa was only based on biopsy outcomes . CONCLUSION Overall csPCa detection was similar between the MRI and control groups . Two-core MRI/TRUS-TB was comparable to 12-core RB for csPCa detection . PATIENT SUMMARY Our r and omized controlled trial revealed a similar rate of prostate cancer detection between targeted biopsy guided by magnetic resonance imaging ( MRI ) and transrectal ultrasound ( TRUS ) and 12-core r and om biopsy . The traditional 12-core r and om biopsy may be replaced by two-core MRI/TRUS targeted biopsy for detection of clinical ly significant prostate cancer
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 .