For the 2025 Prostate Cancer (PCa) Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include:
- Addition of Table 3.1: Definition of familial and hereditary PCa.
- Update of the EAU risk groups for biochemical recurrence of localised and locally-advanced PCa based on systematic biopsy. EAU intermediate-risk group has now been split into favourable and unfavourable.
- Addition of Table 5.3: Sources of error in PSA value assessment
- Significant update to section 5.4.2.4 – MRI in population-based screening protocols.
- Adaption of the recommendation for transperineal biopsy in section 5.6.4.
- Restructure and update of section 5.5.2.6 Surgical techniques for N-staging.
- Updated recommendation for use of prostate-specific antigen-positron emission tomography/computed tomography for staging of intermediate-risk PCa (see section 5.8.5).
- General recommendations for management of PCa have been removed. All recommendations are nor given per disease stage.
- Section 6.6.4 – Combination therapies for management of metastatic PCa has been restructured.
- New recommendation on use of darolutamide in section 6.6.8 - Recommendations for the first-line treatment of hormone-sensitive metastatic disease.
- New recommendation on discussing all patients with hormone-sensitive metastatic disease in a multidisciplinary team in section 6.6.9 - Recommendations for the first-line treatment of hormone-sensitive metastatic disease.
- New recommendation on offering bone protective agents to men on long-term androgen deprivation therapy plus/minus ARPI in the supportive care recommendations in section 6.6.9 related to hormone-sensitive metastatic disease.
- New recommendation in section 7.4.6 for follow-up during hormonal treatment.
- Expansion and update of section 8.2.5 – Androgen deprivation therapy with section 8 – Quality of life outcomes in PCa.