AUA/SUO Advanced Prostate Cancer 2026 Guideline Update - Key Changes for Treatment, Prognosis & More

Published: May 14, 2026

Guideline Video

Guideline Resources

Advanced Prostate Cancer
American Urological Association/Society of Urologic Oncology
May 12, 2026
Summary
Full-text

Video Transcription

Just published May 12th, 2026, the American Urological Association and Society of Urologic Oncology’s newest guideline update on Advanced Prostate Cancer.

This guideline update incorporates newly published literature related to the evaluation and management of advanced prostate cancer to facilitate clinical decision-making, including disease stages ranging from prostate-specific antigen (PSA) recurrence after local therapy to metastatic disease.

In today’s rapid update, we’ll just be going over a summary of new and updated recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started.

Starting with the section on Early Evaluation and Counseling

Germline testing should be offered to all patients with advanced prostate cancer. Somatic tumor testing should be offered to those with metastatic disease.

Next the section on Biochemical Recurrence without Metastatic Disease after Exhaustion of Local Treatment Options, specifically the section on Prognosis

Periodic imaging evaluations should be performed for patients at higher risk of metastases after PSA recurrence following local therapy, with preference for prostate-specific membrane antigen positron emission tomography (PSMA PET) and/or computed tomography (CT), magnetic resonance imaging (MRI), and technetium bone scan.
PSMA PET imaging should be used in patients with PSA recurrence following local therapy.

Now the section on Treatment

Patients with rising PSA after local therapy and no demonstrated metastatic disease should be risk stratified as low- or high-risk.
Routine initiation of androgen deprivation therapy, or ADT, is not recommended in low-risk patients with biochemical recurrence after local therapy.

Moving on to the section on Metastatic Hormone-Sensitive Prostate Cancer, specifically the section on Prognosis

Clinicians should assess metastatic disease extent in newly diagnosed metastatic hormone-sensitive prostate cancer, or mHSPC, patients and stratify based on low- versus high-volume.
A baseline PSA and serial PSAs should be obtained every three to six months after ADT is initiated in mHSPC patients, with consideration of periodic imaging.

Now for the section on Treatment

Most patients with mHSPC should be offered androgen pathway-directed therapy in addition to ADT.
Select patients with mHSPC should be offered ADT combined with docetaxel and either abiraterone acetate plus prednisone or darolutamide.
For select mHSPC patients that have homologous recombination repair, or HRR, gene alterations, clinicians may consider combining ADT with abiraterone and niraparib.

Next the section on Treatment for Metastatic Castration-Resistant Prostate Cancer

Patients who have not received prior androgen receptor pathway inhibitors, or ARPIs, and who are progressing to metastatic castration-resistant prostate cancer, or mCRPC, should be offered continued ADT with abiraterone acetate plus prednisone or enzalutamide.
Docetaxel should be offered to mCRPC patients who are progressing after ARPI treatment.
Clinicians should offer Lu-PSMA-617 to patients with mCRPC with disease progression after ARPI treatment and positive PSMA PET/CT.
Cabazitaxel may be considered to patients with mCRPC who’ve received docetaxel chemotherapy.
Cabazitaxel is recommended over an alternative androgen pathway inhibitor for mCRPC patients previously treated with docetaxel and an androgen pathway inhibitor.
Select patients with deleterious germline or somatic HRR gene-mutated mCRPC may be offered a poly (ADP-ribose) polymerase (PARP) inhibitor.
A PARP inhibitor combined with an ARPI may be offered to select patients with deleterious germline or somatic HRR gene-mutated mCRPC.

And there you have it. Make sure to check out the full guideline from the American Urological Association and Society of Urologic Oncology and other related clinical decision support tools at guidelinecentral.com.