2024 EAU Prostate Cancer Guidelines - some big changes!!

Pelvic lymph node dissection down-graded. Systematic prostate biopsies no longer recommended. More clarity around PSMA PET/CT for staging. Surgery no longer recommended for cN1 prostate cancer. Yep the recent updates to the EAU Prostate Cancer Guidelines had a lot of important changes for the global urology community to digest. So we invited EAU Prostate Cancer Guideline Vice-Chair Derya Tilki, and Guideline Board Member Gianluca Giannarini, along with Elio Mazzone to join us for a deep dive into these major changes. All you need to know!
Your hosts as ever - Professor Declan Murphy and Dr Renu Eapen

Also available as an audio podcast - just search GU Cast wherever you get your podcasts

[barbarameehan]

Thank you Doctors. This was very interesting. My husband was just diagnosed so we are trying to learn all we can.

[RICHARDINTHEKITCHEN]

Thank you for your channel. It is really helpful! I live in the US. My RP and e PLND is scheduled for next week. I'm really concerned about PLND due to its possible life-long complications. My circumstances are as follows: Firm yet no nodular DRE. MP MRI showed 1cm lesion in the peripheral zone with no ECE. PSA 19.4 yet at the time I had CP/CPPS. Systematic biopsy showing (1) 4+4, (4) 4+3 and (1) 3+3. Gleason 8. PSMA Pet showed avidity in only the prostate. No other avidity at distant sites including the nodes and seminal vesicles. BRCA 1 and 2 negative. I'm also asymptomatic in the pelvic region. I'm wondering that, in my setting, can I forego the ePLND? My thinking is to go ahead with the RP only, test PSA every 3 months for two years and if it starts to rise, repeat the PSMA to find it then deal with it. Thanks so much!

[Mark_Lacey]

I did not understand why I had to suffer a biopsy. PSA 2000, bone scan showed extensive mets to upper skeleton, I mean everywhere. PSMA PET Scan after biopsy simply confirmed the bone scan and showed-up a met in a pelvic lymph node. The biopsy was done after the bone scan for what? All it did was raise my PSA to 3500 and I was put on ADT immediately anyway. Result of the biopsy - I couldn't sit down for a week and needed a catheter for six weeks afterwards. It's eventual removal was horrendous for two days after, pissing pure blood, then pushing clots until it cleared up. I sometimes wonder if you doctors and the guidelines you follow understand anything. From what I can make out all it did was give me a Gleason 9 diagnosis, SoC sucks.

[RhondaMcL]

I’m listening with interest in the hope there is some new treatments being considered. My husband had his prostate removed in October last year. He had a Gleason score of 4+5 and post surgery it was upgraded to 5+4. It was borderline breaking out he was told after the pathology, however they were content with how things had gone. He has had 2 PSA tests since surgery, both negligible score but the most recent has showed a PSA level of 0.89. He is pretty devastated and we are waiting for a PET scan. Until this is done we have no idea where it’s popped up again and so I’d appreciate any advice you can give us.

[doctornebula]

If systematic biopsy is still recommended for focal treatment planning, what happens if the initial focused biopsy turns up PCa that requires treatment? Does the patient then have to undergo a systemic biopsy for focal treatment planning?