Clinically Localized Prostate Cancer: AUA/ASTRO Guideline Amendment (2026)

PURPOSE: Following completion of the 2025 Update Literature Review (ULR), the American Urological Association (AUA) incorporated new evidence generated since the 2022 publication of this Guideline via the AUA Amendment process. The resulting 2026 Guideline Amendment addresses updated recommendations to provide a clinical framework for the evaluation and management of clinically localized prostate cancer. MATERIALS AND METHODS: In 2025, this Guideline was reviewed via the AUA ULR process, which identified 29 studies for full-text review that were published between July 1, 2021 and December 5, 2024. An additional 8 studies were identified reviewing artificial intelligence (AI) as it relates to disease management. Relevant studies were incorporated into the Guideline evidence base, and Guideline statements were updated as appropriate. RESULTS: The Panel developed evidence- and consensus-based statements based on an updated review to provide guidance on evaluation and management of clinically localized prostate cancer. These updates are detailed herein. CONCLUSIONS: This Amendment provides several new insights, including revised guidance on imaging, updated information on shared decision-making (SDM), and new direction regarding radiation treatment and disease management. This Guideline will require further review as the diagnostic and treatment options in this space continue to evolve.