The update of the S3 guideline on prostate cancer under the auspices of the German Society of Urology (DGU ) was eagerly awaited by experts: Due to the changed study situation, the scientific society had already held out the prospect of significant modifications to the guideline on the most common tumor disease in men at the end of 2024 during the ongoing revision as part of the oncology guideline programme. In fact, the now published consultation version of version 8 of the evidence-based interdisciplinary S3 guideline on prostate cancer contains far-reaching innovations that will bring about far-reaching changes, particularly in the early detection and diagnosis of prostate cancer as well as in local therapy. The consultation version of the guideline is now publicly available and can be commented on until April 25, 2025.

Prostate cancer is by far the most common malignant tumor disease in men in Germany and is also the second most common cause of cancer-related deaths in men. In 2020, around 65,800 men in Germany were newly diagnosed with prostate cancer; more than 15,400 patients died from the disease. “The importance of the current comprehensive guideline update is correspondingly high,” says DGU guideline coordinator Prof. Dr. Marc-Oliver Grimm.

Early detection: digital rectal examination no longer recommended

Significant innovations in the S3 guideline concern the completely revised and newly merged Chapter 4 “Early detection, diagnosis and staging”. The main new feature here is the recommendation that no digital rectal examination, i.e. no palpation, should be performed for the early detection of prostate cancer. The advantages and disadvantages of PSA-based prostate cancer screening are presented in an overview. Magnetic resonance imaging of the prostate is also being strengthened as part of primary diagnostics. “The key point here is that the biopsy indication should be based even more on image morphological information; in particular, no biopsy should be performed if the MRI findings are unremarkable (so-called PI-RADS 1 and 2 lesions),” explains Prof. Grimm, emphasizing that this recommendation will result in fewer carcinomas being detected that do not require treatment.

Localized prostate cancer with low risk: exclusive recommendation for active surveillance

Extensive changes to the S3 guideline on prostate cancer also apply to Chapter 6 on “Treatment of localized prostate cancer”, which, according to the DGU guideline coordinator, will lead to a significant reduction in overtreatment. “This applies above all to ‘low-risk prostate cancer’, for which localized therapy is no longer recommended initially, but only active surveillance,” says Grimm. His conclusion: “Overall, the guideline in this form is also very progressive by international standards and should make a significant contribution to ensuring that relevant prostate cancer diseases are diagnosed and treated in Germany.”

DGU President Prof. Dr. Bernd Wullich and the Secretary General of the specialist society, Prof. Dr. Maximilian Burger, also emphasize the importance of updating the guidelines: “This is also a decisive step towards establishing an organized risk-adapted PSA-based prostate cancer screening program as a benefit of the statutory health insurance funds in Germany, which the DGU is calling for in line with the EU Council Recommendation (2022/0290 [NLE]) from 2022. The Federal Joint Committee (G-BA) can now review the updated guideline recommendations for the early detection of prostate cancer as planned this year and include them in its decision-making process for adapting the existing early detection program.”

The public now has four weeks to comment on the consultation version of the guideline, which was drawn up with the involvement of a total of 22 specialist societies and working groups/communities. Once the comments have been assessed and processed, the final version of what is now the 8th version of the S3 guideline on prostate cancer will be published as part of the oncology guideline program.

Read also:

Blood test predicts survival of patients with metastatic prostate cancer – MedLabPortal

Liquid biopsy revolutionizes prostate cancer detection – MedLabPortal

CAR T-cell therapy for advanced prostate cancer shows effect – MedLabPortal

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Gender note. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple references and gendered designations are avoided for the sake of better readability ected.