Prostate Cancer: Early Detection, Advanced Treatments, and How Survival Rates Are Rising

Prostate cancer is the most common malignant tumor among men in the Western world. The prostate gland is located at the base of the bladder and plays a crucial role in male fertility. Sometimes, urinary obstruction symptoms can be the first sign of the disease.

In recent years, numerous studies have been conducted to understand what causes prostate cancer. However, since the disease affects all population subgroups and there are no significant known risk factors other than hereditary family history, the exact causes remain partially understood.

Most patients are diagnosed following elevated levels of PSA (Prostate-Specific Antigen) in the blood — a protein secreted by both benign and malignant prostate cells. There is still considerable global debate about whether men over 50 should undergo routine PSA screening. Although the evidence is inconclusive, indirect findings suggest that countries with higher screening rates have seen a decline in prostate cancer mortality.

The core of this debate lies in the fact that such screenings often detect very slow-growing prostate cancers that men could live with without any health impact. This phenomenon, known as “overdiagnosis,” may lead to unnecessary treatments. However, despite the lack of routine screening protocols, it is important for men to be informed and proactive, as early detection can save lives.

The Treatments That Changed the Landscape

Once elevated PSA levels are detected, the diagnostic process continues with a prostate MRI, followed by a targeted biopsy. If cancer is found, a full-body scan is conducted to detect metastases, after which the appropriate treatment plan is determined.

In recent years, advances in diagnostic and treatment technologies, along with the ability to classify and differentiate between cancer subtypes, have significantly improved recovery rates. Today, over 90% of prostate cancer patients have high survival rates, with treatment plans tailored to the level of risk and the presence of metastases.

For higher-risk cases, treatment decisions may include surgery or radiation therapy. In some instances, a combination of radiation and hormonal therapy is chosen. Hormonal treatments work by lowering testosterone, the growth hormone for prostate cancer cells, essentially “starving” them. However, this method often faces eventual resistance as the cancer adapts.

Thanks to recent breakthroughs, there are now alternative and advanced treatments for cases where hormonal therapy is no longer effective. One of the most significant innovations in recent years is the development of radioactive treatments that deliver localized, internal radiation directly to cancerous tissues throughout the body.

This approach binds radioactive substances to cancer cells, effectively targeting metastases, significantly reducing tumor burden, alleviating pain, and extending survival, with minimal side effects.

Recent insights have also shown that starting combination treatments at the initial diagnosis stage — beyond basic hormonal therapy — can improve recovery rates. Further innovations focus on genetic mutations relevant to about 20% of prostate cancer patients, for whom specific biological therapies have been developed.

Overall, it is important to understand that today there are more treatment options, more ways to live with prostate cancer, and even in advanced and metastatic stages, new treatments such as radioactive therapies, which allow patients to maintain a good quality of life.

The author is the Director of the Urologic Oncology Unit at Beilinson Hospital.