Guía de la EAU sobre el cáncer de próstata: Parte I: cribado, diagnóstico y tratamiento del cáncer clínicamente localizado

objective: our aim was to present a summary of the 2010 version of the european association of urology (eau) guidelines on the screening, diagnosis, and treatment of clinically localised cancer of the prostate (pca). methods: the working panel performed a literature review of the new data emerging from 2007 to 2010. the guidelines were updated, and level of evidence and grade of recommendation were added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. results: a full version is available at the eau office or web site (www.uroweb.org). current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (psa) for pca. a systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method. active surveillance represents a viable option in men with low-risk pca and a long life expectancy. psa doubling time in < 3 yr or a biopsy progression indicates the need for active intervention. in men with locally advanced pca in whom local therapy is not mandatory, watchful waiting (ww) is a treatment alternative to androgen-deprivation therapy (adt) with equivalent oncologic efficacy. active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy (rp) shown to be superior to ww in a prospective randomised trial. nerve-sparing rp represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. radiation therapy should be performed with at least 74gy and 78gy in low-risk and intermediate/high-risk pca, respectively. for locally advanced disease, adjuvant adt for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice. follow-up after local therapy is largely based on psa, and a disease-specific history with imaging is indica