The EAU, with the nuclear medicine, radiotherapy, urogenital radiology, uropathology and geriatric oncology societies, has updated its localised prostate cancer guideline covering screening, diagnosis and treatment with curative intent, reviewing data published between May 2023 and 2025 and attaching a strength rating to each recommendation.

The substantive changes group into three. On detection: a risk-adapted strategy starting at about 50 years and tied to individual life expectancy, not a blanket PSA age. On diagnosis: multiparametric MRI to avoid unnecessary biopsy, and when biopsy is indicated, targeted plus regional cores rather than either alone; PSMA PET is named as the most sensitive way to find metastatic spread. On treatment: a new five-tier EAU risk classification replaces the three-group habit, active surveillance is appropriate for low-risk disease and now for selected favourable intermediate-risk ISUP grade group 2 lesions, hypofractionated radiotherapy is to be considered in intermediate-risk patients, and cN1 disease should be offered radiotherapy to the primary combined with long-term intensified hormonal treatment.

The extension of surveillance into grade group 2 and the five-tier classification are the two that will change conversations soonest. In Indian practice the constraint is access rather than agreement: mpMRI before biopsy and PSMA PET are both recommended and both are out of reach for many patients paying directly, so the practical question becomes which single test changes management most for a given man - usually the MRI, because it can avoid a biopsy altogether.

Start risk-adapted detection discussions around age 50, framed by life expectancy rather than a fixed age cut-off
Obtain multiparametric MRI before biopsy where it is available, to avoid unnecessary biopsies
Take targeted and regional cores together when biopsy is indicated
Offer active surveillance for selected favourable intermediate-risk grade group 2 disease, not only low risk
Where cost limits imaging, prioritise pre-biopsy MRI over PSMA PET in localised disease

Why it matters

Active surveillance crossing into grade group 2 changes which men are told they can safely be watched rather than treated.

Don't overread it

A guideline summary published in July 2026 covering evidence to 2025; the five-tier classification is new and its prognostic performance in routine practice is not yet established.