The newest ESMO guidelines for locoregional prostate cancer reinforces risk-stratified diagnosis with pre-biopsy multiparametric MRI. Management emphasizes de-intensification where safe such as active surveillance for low-risk and selected favorable intermediate-risk disease as well as a general preference for post-prostatectomy early salvage versus routine adjuvant radiation. On the other hand, validated intensification for high-risk disease includes long-course ADT with radiation as well as abiraterone for very high-risk or cN1 disease. PSMA-PET is endorsed for staging in unfavorable intermediate to very high-risk disease and for biochemical recurrence without denying local therapy based on PET-only upstaging. | Walz, Ann Oncol 2025
