2026 update on EAU Guidelines for Prostate Cancer

So compared to last year where some, I would say, major changes happened, this year there are a bit less change that we will discuss within the interview.

So I would start with localized disease.

Daria, what do you think are the changes that are worth mentioning and our colleagues should know about this year's edition?

Yeah, thank you very much for the opportunity to highlight the changes.

You said it very correctly.

There actually haven't been that major changes this year.

Last year, we had changed the EAU risk groupings where we subdivided the intermediate risk grouping into favorable and unfavorable intermediate risk, similar to the NCCN guidelines.

This year, we slightly updated it again to be more conformed with the Cambridge risk groups, which have been also validated for a mortality endpoint.

Another important change is also our recommendations for high-risk PCR.

According to the MBARC data, there was an update presented on overall survival at ESMO.

this year, and we saw the impressive overall survival advantage in the patients receiving enzalutamide plus ADT, but this overall survival was not seen in patients with enzalutamide monotherapy.

That's why that recommendation has changed to enzalutamide plus ADT instead of plus minus ADT.

So those are some of the Okay,

so the overall survival data make you change in terms of ENSA and ADT.

ENSA monotherapy isn't a recommendation.

And concerning diagnostic, I had a look at the guidance and I saw you added a section on micro-ultrasound based on the Optima trial.

Do you want to give us some insight on

that? Correct.

So we, in general, we added some new sections in the text, but sometimes didn't do a recommendation for that where there's not so much data out there.

The trial looked at a biopsy strategy with micro ultrasound, which instead of MRI and also one arm with a combination of micro ultrasound and MRI and showed that it wasn't inferior to the MRI fusion biopsy.

the detection rates of significant prostate cancer but it is a study which is in high volume centers it was done and not many centers have micro ultrasound available yet so there has to be more numbers and more validations until there can be clear recommendations so at this moment we don't have a recommendation to use micro ultrasound in general.

Okay.

So the signal from trial is good, but the resource availability is another issue that needs further evidence.

And I saw, compared to Optima, you didn't refer to the NeuroSafe trial within the guidelines.

Is that correct?