Prostate-specific Antigen Testing as Part of a Risk-Adapted Early Detection Strategy for Prostate Cancer: European Association of Urology Position and Recommendations for 2021

Hendrik Van Poppel*, Monique J. Roobol, Christopher R. Chapple, James W.F. Catto, James N'Dow, Jens Sønksen, Arnulf Stenzl, Manfred Wirth

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

98 Citations (Scopus)


Background: Recommendations against prostate-specific antigen (PSA) testing in 2012 have increased advanced-stage diagnosis and prostate cancer–specific mortality rates. Objective: To present the position of the European Association of Urology (EAU) in 2021 and provide recommendations for the use of PSA testing as part of a risk-adapted strategy for the early detection of prostate cancer. Evidence acquisition: The authors combined their review of relevant literature, including the EAU prostate cancer guidelines 2021 update, with their own knowledge to provide an expert opinion, representing the EAU's position in 2021. Evidence synthesis: The EAU has developed a risk-adapted early prostate cancer detection strategy for well-informed men based on PSA testing, risk calculators, and multiparametric magnetic resonance imaging, which can differentiate significant from insignificant prostate cancer. This approach largely avoids the overdiagnosis/overtreatment of men unlikely to experience disease-related symptoms during their lifetime and facilitates an early diagnosis of men with significant cancer to receive active treatment. It also reduces advanced-stage diagnosis, thereby potentially reducing prostate cancer–specific mortality and improving quality of life. Education is required among urologists, general practitioners, radiologists, policy makers, and healthy men, including endorsement by the European Commission to adapt the European Council's screening recommendations in its 2022 plan and requests to individual countries for its incorporation into national cancer plans. Conclusions: This risk-adapted approach for the early detection of prostate cancer will reverse current unfavourable trends and ultimately save lives. Patient summary: The European Association of Urology has developed a patient information leaflet and algorithm for the early diagnosis of prostate cancer. It can identify men who do not need magnetic resonance imaging or a biopsy and those who would not show any symptoms versus those with more aggressive disease who require further tests/treatment. We need to raise awareness of this algorithm to ensure that all well-informed men at risk of significant prostate cancer are offered a prostate-specific antigen test. Take Home Message: A risk-adapted early prostate cancer detection strategy, incorporating prostate-specific antigen testing, multiparametric magnetic resonance imaging, risk calculators, and biomarkers, will avoid overdiagnosis/overtreatment of insignificant cancers and ensure early detection and treatment of significant cancers, thereby improving quality of life and reducing prostate cancer–related deaths.

Original languageEnglish
Pages (from-to)703-711
Number of pages9
JournalEuropean Urology
Issue number6
Early online date15 Aug 2021
Publication statusPublished - Dec 2021

Bibliographical note

Acknowledgements: The authors would like to thank R. Hogenhout, P. Albers, R. Van den Bergh, and J. Barentsz for their contribution to the design of our risk-adapted algorithm for the early detection of prostate cancer. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded by the European Association of Urology .

Funding Information:
Hendrik Van Poppel certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: James W.F. Catto has received reimbursement for consultancy from Astra Zeneca, Roche, and Janssen; speaker fees from BMS, MSD, Nucleix, and Roche; and honoraria for membership of advisory boards from Astra Zeneca, Ferring, Roche, and Janssen. James W.F. Catto is funded by an NIHR Research Professorship. All other authors have declared no conflict of interest relevant to the content of this manuscript.


  • Active surveillance
  • Biomarkers
  • Early detection of cancer
  • Education
  • Multiparametric magnetic resonance imaging
  • Prostate cancer
  • Prostate-specific antigen
  • Risk stratification
  • Screening


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