Today, we are outlining key recommendations from the American Urological Association (AUA) and American Society for Radiation Oncology (ASTRO) guideline update for Clinically Localized Prostate Cancer. This 2026 update replaces the previous version, published in 2022, and integrates newly published literature related to the evaluation and management of clinically localized prostate cancer. The recommendations provide a framework to facilitate clinical decision making across risk stratification, staging, management, and follow-up care.

In today’s spotlight, we will focus on key highlights from the recommendations that are new or updated in the 2026 guideline. Refer to the full-text version of the guideline for the complete and most thorough explanation of these recommendations. 

Key Highlights from the 2026 Clinically Localized Prostate Cancer Guideline

Staging

  • The guideline states that prostate MRI may be used to guide surveillance biopsies, evaluate location and extent of prostate disease, and assist with treatment planning. 
  • For asymptomatic patients with prostate cancer that is low- or favorable intermediate-risk, clinicians should not regularly perform nodal or metastatic staging bone scans, cross-sectional imaging, or prostate-specific membrane antigen positron emission tomography (PSMA PET) scan. 
  • For staging of unfavorable intermediate- and high- risk localized prostate cancer, clinicians should use either a combination of cross-sectional imaging and bone scan, or PSMA PET.
  • For the evaluation of metastases, clinicians may consider using PSMA PET for patients with unfavorable intermediate and high- risk localized prostate cancer with negative conventional imaging. 

Risk-Based Management

  • For patients with low- and intermediate-risk prostate cancer, clinicians should inform patients that focal or whole gland ablation is still considered investigational.

Principles of Radiation

  • Androgen deprivation therapy (ADT) may be initiated concurrently or neoadjuvantly when combined ADT and radiation are utilized. 
  • For select patients with high-risk localized or locally advanced prostate cancer undergoing radiation therapy, clinicians should combine androgen deprivation therapy with abiraterone acetate and prednisone for 24 months.

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