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 .
Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer.
PURPOSE Conventional radiotherapy ( C-RT ) treatment schedules for patients with prostate cancer typically require 40 to 45 treatments that take place from > 8 to 9 weeks . Pre clinical and clinical research suggest that hypofractionation-fewer treatments but at a higher dose per treatment-may produce similar outcomes . This trial was design ed to assess whether the efficacy of a hypofractionated radiotherapy ( H-RT ) treatment schedule is no worse than a C-RT schedule in men with low-risk prostate cancer . PATIENTS AND METHODS A total of 1,115 men with low-risk prostate cancer were r and omly assigned 1:1 to C-RT ( 73.8 Gy in 41 fractions over 8.2 weeks ) or to H-RT ( 70 Gy in 28 fractions over 5.6 weeks ) . This trial was design ed to establish ( with 90 % power and an α of .05 ) that treatment with H-RT results in 5-year disease-free survival ( DFS ) that is not worse than C-RT by more than 7.65 % ( H-RT/C-RT hazard ratio [ HR ] < 1.52 ) . RESULTS A total of 1,092 men were protocol eligible and had follow-up information ; 542 patients were assigned to C-RT  and 550 to H-RT . Median follow-up was 5.8 years . Baseline characteristics were not different according to treatment assignment . The estimated 5-year DFS was 85.3 % ( 95 % CI , 81.9 to 88.1 ) in the C-RT arm and 86.3 % ( 95 % CI , 83.1 to 89.0 ) in the H-RT  arm . The DFS HR was 0.85 ( 95 % CI , 0.64 to 1.14 ) , and the predefined noninferiority criterion that required that DFS outcomes be consistent with HR < 1.52 was met ( P < .001 ) . Late grade 2 and 3 GI and genitourinary adverse events were increased ( HR , 1.31 to 1.59 ) in patients who were treated with H-RT . CONCLUSION In men with low-risk prostate cancer , the efficacy of 70 Gy in 28 fractions over 5.6 weeks is not inferior to 73.8 Gy in 41 fractions over 8.2 weeks , although an increase in late GI/genitourinary adverse events was observed in patients treated with H-RT
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 .