Localised prostate cancer just changed. Again. ESMO 2026 brings clarity on who to observe, who to escalate, and which trials actually matter 👇 🧠 Diagnosis MRI before biopsy is standard High-resolution US is a valid alternative (RCT n=678) 🧭 Low risk Active surveillance is safe ProtecT 15-yr data shows similar survival vs RP/RT ☢️ Radiotherapy Shorter is better CHHiP ➜ moderate hypofractionation HYPO-RT-PC ➜ ultra-hypofractionation PACE-B ➜ SBRT works in selected IR disease 📈 High risk RT + long-term ADT saves lives SPCG-7 | NCIC/MRC Dose escalation improves OS (GETUG-AFU 18) 🚨 Very high-risk / cN1 RT + ADT + abiraterone is the new benchmark STAMPEDE delivers MFS + OS benefit 🔁 Biochemical recurrence Avoid routine adjuvant RT Early salvage RT preferred RADICALS-RT | RAVES | GETUG-AFU 17 High-risk BCR? Intensify EMBARK supports enzalutamide + ADT 🧠 Bottom line Risk-adapted care > overtreatment Imaging-driven decisions Escalate only when trials prove benefit 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #ProstateCancer #GUOncology @OncoAlert @myesmo @esmo_open @asco @OncBrothers