OBJECTIVE:Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy. MATERIALS AND METHODS:Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1-7, 1-14, and 1-30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed. RESULTS:Thirty-one thousand two hundred twenty-two men underwent biopsy between 1 January 2020 and 31 December 2023. 87% underwent TR and 13% TP biopsy. Hospitalization occurred in 0.6% of men (n = 24) after TP biopsy and 2.0% (n = 548) after TR biopsy. Rate ratios for hospitalization in the TR group compared to TP were 8.0 (95% confidence interval [CI]: 4.0-16.2) for day 1-7, 6.2 (3.2-11.9) for day 1-14, and 4.1 (2.4-6.8) for day 1-30. Filled antibiotic prescriptions were found for 4.5% of men (n = 187) after TP biopsy and 6.9% (n = 1,883) after TR biopsy. For antibiotic prescriptions, the rate ratios were 2.3 (1.8-2.9) for day 1-7 as well as day 1-14, and 1.6 (1.3-1.9) for day 1-30. CONCLUSIONS:A transrectal prostate biopsy was associated with a significantly higher risk of post-biopsy infectious complications compared to transperineal biopsy. These findings support the use of transperineal biopsy.

This study aimed to investigate the feasibility of MR diffusion imaging of fresh prostate needle biopsy cores in a 14 Tesla vertical bore NMR system. Biopsies sampled from the index tumor and a presumed tumor-free area of eight prostatectomy specimens underwent diffusion-weighted imaging using conventional pulsed gradient spin echoes (PGSE) and stimulated echo acquisition mode (STEAM) with different gradient separation times between 10 and 400 ms at nominal b values ranging from 0 up to 5000 s/mm2. The apparent diffusion coefficient (ADC) was determined over the b-value range 0-1000 s/mm2. Kurtosis and biexponential models were fitted to measured signals at effective b values within the range 0-2000 and 0-5000 s/mm2, respectively. Moreover, monoexponential models were fitted over the same b-value ranges. After imaging, all biopsies underwent histopathological evaluation. For all diffusion gradient separation times evaluated, the ADC of histopathologically confirmed tumor and normal tissue was not significantly different (p = 0.140 at 10 ms gradient separation time). Irrespective of the investigated tissue type, for an increasing gradient separation time up to 150 ms ADC decreased. For longer times up to 400 ms no further change was evident. For short diffusion gradient separation times, the Akaike information criterion (AIC) favored the biexponential model in almost all voxels, but for longer diffusion gradient separation times, in a majority of voxels the AIC favored the monoexponential model over either the kurtosis or biexponential model. Imaging of fresh prostate biopsies is feasible. At short diffusion times, in agreement with the presence of at least two distinct compartments, the signal decay is well described by a biexponential model. At long diffusion times, the ADC is lower, and a monoexponential model tends to be more appropriate, indicating the presence of exchange between compartments.

BACKGROUND AND OBJECTIVE:To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, metastatic hormone-sensitive and castration-resistant prostate cancer (PCa). METHODS:The Panel performed a literature review of new data, covering the time frame between 2023 and 2025. The Guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS:Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. The range of treatment options for metastatic PCa has broadened, including androgen receptor pathway inhibitors (ARPI), metastasis-directed therapy, PARP inhibitors and their combinations, as well as PSMA-based therapy. The recommendations in the EAU Guidelines are based on clinical evidence and do not account for variations in cost, reimbursement structures, or resource availability across healthcare systems. CONCLUSIONS AND CLINICAL IMPLICATIONS:The evidence in the field of relapsing, metastatic, and castration-resistant PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management. A full version is available from the EAU Guidelines Office or online (http://uroweb.org/guideline/ prostate-cancer/).

Objective: This article presents a summary of the 2025 Swedish prostate cancer guidelines, focusing on recurrence after local treatment, metastatic disease, and castration-resistant prostate cancer. Results: The 2025 Swedish guidelines introduce several important updates. Prostate specific membrane antigen (PSMA)-PET/CT is recommended only when PSA exceeds 0.2 µg/L, and reporting should follow the defined PSMA-RADS-scale. PSMA-PET/CT is preferred over lymph-node dissection for staging. A strong recommendation is issued for radiotherapy to the primary tumour in all oligometastatic men with a life expectancy > 5 years, whereas metastasis-directed therapy is restricted to clinical trials. Systemic treatment pathways now prioritise androgen receptor pathway inhibitors (ARPI) plus androgen deprivation therapy (ADT), with triple therapy (including docetaxel) used more selectively. Pathway-specific staging algorithms have been revised. The oly (ADP-ribose) polymerase inhibitor (PARPi) section has expanded, with broader genomic-based selection and integration into treatment sequencing. Two new chapters and an appendix address cardiovascular risk assessment before ARPI or chemotherapy. Supportive care is substantially strengthened. Compared with the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2025, the Swedish guidelines 2025 applies PSMA-PET/CT more conservatively, restricts PSMA-guided nodal salvage therapy, and issues a more universal recommendation for local radiotherapy in oligometastatic disease. The Swedish guidelines 2025 prioritise ARPI + ADT and limit triple therapy and PARPi combinations due to regulatory and reimbursement constraints. PARPi are largely reserved for BRCA1/2-mutated disease. The Swedish guidelines 2025 provide a more comprehensive framework for rehabilitation and survivorship. Conclusions: The 2025 Swedish prostate cancer guidelines introduce multiple new recommendations and differ in several aspects from the European guidelines.

BACKGROUND AND OBJECTIVE:To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa). METHODS:The Panel performed a literature review of all new data published in English, covering the time frame between May 2023 and 2025. The Guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS:A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. A new five-tier EAU classification has been introduced. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for patients with selected favourable intermediate-risk ISUP grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionated radiotherapy in intermediate-risk patients is provided. Patients with cN1 PCa should be offered radiotherapy to the primary tumour combined with long-term intensified hormonal treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS:The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management.

BACKGROUND AND OBJECTIVE:Localized prostate cancer can be treated with either robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP). This study aimed to analyze all-cause and prostate cancer-specific mortality 12 yr after surgery. METHODS:The nonrandomized multicenter LAParoscopic Prostatectomy Robot Open (LAPPRO) trial enrolled patients from 2008 to 2011. The eligibility criteria included age <75 yr, prostate-specific antigen <20 ng/ml, clinical stage <T4, nonmetastatic disease, and informed consent. Data were collected through validated questionnaires at baseline and clinical record forms repeatedly up to 12 yr after surgery, with mortality information retrieved from Sweden's National Cause of Death Register. The main outcomes were all-cause and prostate cancer-specific mortality. KEY FINDINGS AND LIMITATIONS:Of the 4003 patients enrolled in LAPPRO, 3583 were eligible for the current analysis, of whom 2698 (75%) underwent RALP and 885 (25%) RRP. At 12 yr after surgery, prostate cancer-specific mortality was significantly lower after RALP than after RRP (55/2698 [2.0%] vs 40/885 [4.5%]; adjusted hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.23-0.55). The numbers of all-cause deaths were 371/2698 (14%) in the RALP group and 145/885 (16%) in the RRP group (adjusted HR 0.81, 95% CI 0.66-0.99). The study is limited by its nonrandomized design. CONCLUSIONS AND CLINICAL IMPLICATIONS:At 12 yr after surgery, prostate cancer-specific mortality was significantly lower in patients undergoing robotic prostatectomy than in those undergoing open prostatectomy. Cautious interpretation is suggested for the possible causal effect, but the results suggest that the robotic technique is associated with a better oncological outcome.

A phytoestrogen-rich diet has been suggested to reduce tumor proliferation among men with prostate cancer, and the effect may differ between men with different polymorphisms of the estrogen receptor-beta gene (ER beta). Patients with low- or intermediate-risk prostate cancer scheduled for radical prostatectomy were randomized to an intervention group (n = 71) provided with soybeans and flaxseeds (similar to 200 mg phytoestrogens/day) to eat until surgery (approximately 6 wk) or to a control group (n = 69). Tumor proliferation was assessed using Ki-67 indexes, prostate-specific antigen (PSA) concentrations were analyzed in blood, and ER beta polymorphism was genotyped in all subjects. The intervention group had a 13% unit lower risk [95% confidence interval (CI): -28%, 1.8%] of a higher Ki-67 index compared to controls, but the effect was most pronounced among TT carriers of ER beta [risk difference (RD) -19%, 95% CI: -45%, 6.8%]. Subjects with genotype TC/CC had a lower risk (RD -29%, 95% CI: -46%, -1.2%) and TT genotype a higher risk (RD 25%, 95% CI: 8.7%, 42%) of increased PSA concentration, comparing the intervention group to controls. In conclusion, a phytoestrogen-rich diet may cause lower tumor proliferation and concentration of PSA in men with prostate cancer with a specific genetic upset of ER beta.

BACKGROUND AND OBJECTIVE:Postprostatectomy urinary incontinence (PPI) is a common complication following robot-assisted laparoscopic radical prostatectomy (RALP), with incidence rates of 4-31%. This study examines associations between patient- and surgery-specific risk factors and PPI. METHODS:We analysed data from 13 754 men who underwent RALP between 2017 and 2021, registered in the National Prostate Cancer Register of Sweden. Electronic patient-reported outcome measure (ePROM) questions were completed by 37% at 3 mo and 47% after 12 mo, including questions on pad use. PPI was defined as the use of more than one pad (primary) and any pad use (secondary). Poisson regression assessed the associations between PPI and factors such as age, comorbidity, prostate volume, nerve-sparing procedures, and surgical details. KEY FINDINGS AND LIMITATIONS:At 12 mo, 17% (1086/6413) reported the use of more than one pad and 49% (3113/6413) reported any pad use. Significant risk factors for incontinence in a multivariable analysis (more than one pad) included age ≥75 versus <65 yr (p < 0.001; relative risk [RR] 2.03; 95% confidence interval [CI] 1.67-2.48), urethral division with margin from the apex versus maximal urethra length (p < 0.001; RR 1.95; 95% CI 1.57-2.43), non-nerve-sparing procedures (p < 0.001; RR 1.70; 95% CI 1.432.03), and prostate volume ≥90 versus <30 ml (p = 0.018; RR 1.47; 95% CI 1.07-2.01). Limitations included missing data on surgical variables and a relatively low ePROM response rate. CONCLUSIONS AND CLINICAL IMPLICATIONS:Older age, large prostate size, and non-nerve-sparing surgery increase the risk of PPI, underscoring the importance of shared decision-making in treatment planning. However, these factors explain only a part of PPI.

The role of extended pelvic lymph-node dissection (ePLND) in prostate cancer has been revisited in light of evidence from studies on staging via prostate-specific membrane antigen positron emission tomography/computed tomography. It is difficult to predict which individuals might benefit from ePLND. Patients should be counselled about this uncertainty and the risks of ePLND-associated morbidity as part of the shared decision-making process.

Objective: Catheter-associated urinary tract infections (CAUTIs) are prevalent healthcare-associated infections, arising from biofilm-forming bacteria. This may be prevented by coating the catheter with an antifouling substance. The novel LubriShield™ Foley catheter is coated with a superhydrophilic surface and a covalently bonded antifouling ligand. Preclinical studies revealed that the coating established a persistent local antifouling environment, inhibiting uropathogenic bacteria from forming biofilms. No substance release has been detected from the coating. The coating achieved a 28-fold reduction in surface friction compared to an uncoated catheter. The aim of this study is to assess the clinical safety of the catheter in patients. Materials & methods: In a prospective single-centre randomised study, 30 patients undergoing transurethral resection of bladder tumour were enrolled and randomly assigned to receive either a standard control catheter or the novel LubriShield™ catheter. Urinary cultures were obtained twice. The duration of catheterisation for the patients ranged from 3 to 24 h. The primary outcome was the assessment of device-specific adverse events (AEs). Secondary outcomes included evaluations of pain, irritation and discomfort, measured using the Numeric Rating Scale (NRS) (0–10) via a patient questionnaire. Results: There were no serious adverse events (SAEs) or AEs reported for the coated catheters. Urinary cultures showed no significant differences between the coated and uncoated catheters. Both patients and healthcare professionals rated the NRS equally for the two types of catheters. Conclusions: The novel-coated LubriShield™ catheter was found to be safe for short-term clinical use.

Objective: To describe the study design and procedures of the incontinence post robot- assisted radical prostatectomy, anatomical and functional causes (IPA) trial. This trial aims to identify and study patient and procedure specific factors leading to urinary incontinence post robot-assisted laparoscopic radical prostatectomy (RALP). Material and methods: The IPA study is a prospective, multicentre, open non-randomised surgical trial, including patients prior to RALP and registered on-line (ISRCTN67297115). IPA is administered from the Department of Urology at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients undergo an anatomical and functional evaluation using magnetic resonance imaging (MRI), urodynamics including cystometry, pressure-flow and urethral pressure profile, and dynamic transrectal ultrasound prior to and 3 months after RALP. The incontinence data are gathered using patient reported outcome measure questionnaires. The primary endpoint is incontinence at 3 months after RALP, defined as need of any pad. The secondary endpoints are incontinence 12 months post RALP defined as need of any pad, and 3- and 12-months post RALP, defined as use of more than a safety pad. Results: Until October 2023, 207 patients have been included of the stipulated 1,000, with an increasing rate of accrual. Out of these patients,187 have had a pre- and post-operative MRI and 177 have undergone pre- and post-operative urodynamics. Conclusions: The design of the IPA study, together with promising accrual and coming multicentre inclusion, will hopefully result in the identification, and deeper understanding, of the various risk-factors for post-RALP incontinence. This could improve information and decision making regarding adequate treatment for patients with prostate cancer.

There is a long history of curative treatment of prostate cancer. However, as prostate cancer often grows very slowly, and symptoms do not have time to develop during a person's lifetime, a more tentative approach has become more and more common in many cases. This may be through either watchful waiting or active surveillance. In the first case palliative hormonal treatment is given in the case of progression, in the latter curative treatment would be the choice. When treatment is deemed necessary for localized disease, surgery and radiotherapy are considered equivalent in terms of efficacy and overall risk of side effects. For locally advanced disease, radiotherapy is the recommended first-hand choice outside the SPCG 15 study. Focal treatment, which may lead to less side effects than surgery or radiotherapy, is not recommended outside trial settings due to lack of long-term follow-up data.

Context: The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain. Objective: To perform a systematic review to determine the benefits and harms of EBRT-BT. Evidence acquisition: Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT +/- androgen deprivation therapy (ADT) and/or radical prostatectomy (RP) +/- postoperative radiotherapy (RP +/- EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs). Evidence synthesis: Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p < 0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p = 0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p = 0.4). Fewer studies examined RP +/- EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs. Conclusions: EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control. Patient summary: We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear. (c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background and objectiveThe European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines provide recommendations for the management of clinically localised prostate cancer (PCa). This paper aims to present a summary of the 2024 version of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on the screening, diagnosis, and treatment of clinically localised PCa.MethodsThe panel performed a literature review of all new data published in English, covering the time frame between May 2020 and 2023. The guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence.Key findings and limitationsA risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging in order to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for selected favourable intermediate-risk patients with International Society of Urological Pathology grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionation in intermediate-risk patients is provided. Patients with cN1 PCa should be offered a local treatment combined with long-term intensified hormonal treatment.Conclusions and clinical implicationsThe evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa guidelines reflect the multidisciplinary nature of PCa management.Patient summaryThis article is the summary of the guidelines for “curable” prostate cancer. Prostate cancer is “found” through a multistep risk-based screening process. The objective is to find as many men as possible with a curable cancer. Prostate cancer is curable if it resides in the prostate; it is then classified into low-, intermediary-, and high-risk localised and locally advanced prostate cancer. These risk classes are the basis of the treatments. Low-risk prostate cancer is treated with “active surveillance”, a treatment with excellent prognosis. For low-intermediary-risk active surveillance should also be discussed as an option. In other cases, active treatments, surgery, or radiation treatment should be discussed along with the potential side effects to allow shared decision-making.

BACKGROUND Data on the efficacy and safety of screening for prostate cancer with magnetic resonance imaging (MRI) are needed from studies of follow-up screening. METHODS In a population-based trial that started in 2015, we invited men who were 50 to 60 years of age to undergo prostate-specific antigen (PSA) screening. Men with a PSA level of 3 ng per milliliter or higher underwent MRI of the prostate. Men were randomly assigned to the systematic biopsy group, in which they underwent systematic biopsy and, if suspicious lesions were found on MRI, targeted biopsy, or the MRI-targeted biopsy group, in which they underwent MRI-targeted biopsy only. At each visit, men were invited for repeat screening 2, 4, or 8 years later, depending on the PSA level. The primary outcome was detection of clinically insignificant (International Society of Urological Pathology [ISUP] grade 1) prostate cancer; detection of clinically significant (ISUP grade >= 2) cancer was a secondary outcome, and detection of clinically advanced or high-risk (metastatic or ISUP grade 4 or 5) cancer was also assessed. RESULTS After a median follow-up of 3.9 years (approximately 26,000 person-years in each group), prostate cancer had been detected in 185 of the 6575 men (2.8%) in the MRI-targeted biopsy group and 298 of the 6578 men (4.5%) in the systematic biopsy group. The relative risk of detecting clinically insignificant cancer in the MRI-targeted biopsy group as compared with the systematic biopsy group was 0.43 (95% confidence interval [CI], 0.32 to 0.57; P<0.001) and was lower at repeat rounds of screening than in the first round (relative risk, 0.25 vs. 0.49); the relative risk of a diagnosis of clinically significant prostate cancer was 0.84 (95% CI, 0.66 to 1.07). The number of advanced or high-risk cancers detected (by screening or as interval cancer) was 15 in the MRI-targeted biopsy group and 23 in the systematic biopsy group (relative risk, 0.65; 95% CI, 0.34 to 1.24). Five severe adverse events occurred (three in the systematic biopsy group and two in the MRI-targeted biopsy group). CONCLUSIONS In this trial, omitting biopsy in patients with negative MRI results eliminated more than half of diagnoses of clinically insignificant prostate cancer, and the associated risk of having incurable cancer diagnosed at screening or as interval cancer was very low.

Background and objective: The European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (PCa) have been updated. Here we provide a summary of the 2024 guidelines. Methods: The panel performed a literature review of new data, covering the time frame between 2020 and 2023. The guidelines were updated and a strength rating for each recommendation was added on the basis of a systematic review of the evidence. Key findings and limitations: Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. New treatment options, such as androgen receptor-targeted agents (ARTAs), ARTA + chemotherapy combinations, PARP inhibitors and their combinations, and prostate-specific membrane antigen-based therapy have become available for men with metastatic PCa. Conclusions and clinical implications: Evidence for relapsing, metastatic, and castration- resistant PCa is evolving rapidly. These guidelines reflect the multidisciplinary nature of PCa management. The full version is available online (http://uroweb.org/guideline/ prostate-cancer/). Patient summary: This article summarises the 2024 guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are based on evidence and guide doctors in discussing treatment decisions with their patients. The guidelines are updated every year. (c) 2024 Published by Elsevier B.V. on behalf of European Association of Urology.