New Tools in the Fight Against Prostate Cancer: A Modern Approach

Prostate cancer is the most common malignant tumor among men in Israel and the Western world. In Israel alone, around 2,500 new patients are diagnosed each year, and its prevalence increases with age. The prostate gland is located at the base of the bladder and plays a crucial role in male fertility. Blockage symptoms in urine flow can sometimes be the first sign.

In recent years, many studies have been conducted to understand the causes, but because the disease affects all sub-populations and no significant risk factors are known apart from hereditary family risk, a definitive understanding is still lacking.

Most patients are diagnosed following an increase in PSA levels in the blood, a protein also secreted by benign prostate cells. However, there is still much debate worldwide over whether men over 50 should undergo routine screening tests for it. Although the evidence is not definitive, there are indirect indications that countries with more frequent screenings have seen a decrease in mortality.

The controversy stems from the fact that such tests can sometimes detect very slow-growing prostate cancers that people can live with, leading to "over-diagnosis" and potentially unnecessary treatments. Despite this, and even though routine screenings aren't performed, it's important to discuss and consider it with doctors since early detection can save lives.

Treatments That Have Changed the Game

After high PSA levels are found in the blood, diagnosis continues with an MRI of the prostate, followed by a targeted biopsy. If cancer is detected, further tests are conducted to check the spread throughout the body, and only then is a treatment decision made.

Recent improvements in diagnostic and treatment methods, along with the ability to classify and differentiate between various subtypes of cancer, allow for more personalized treatments. As a result, recovery rates for prostate cancer now exceed 90%, with treatments determined based on risk levels and the presence of metastases, if any.

In higher-risk cases, treatment decisions may include surgery or radiation therapy. In some cases, radiation therapy might be combined with hormone therapy, which reduces testosterone, the growth hormone of prostate cancer cells, essentially "starving" them, although resistance to this treatment often develops over time.

Due to numerous recent breakthroughs, there are also other advanced treatments for cases where hormone therapy is no longer effective. One of the major innovations in recent years is the advent of radioactive treatments that deliver internal, localized radiation to all affected areas.

These treatments, which attach to cancer cells and can target all parts of the body, are highly effective, alleviate pain, significantly reduce metastases, and have been proven to extend life with minimal side effects. Although not currently covered by health insurance in Israel, they are now available and subsidized for those with private insurance.

It has also become apparent in recent years that providing additional treatments beyond basic hormone therapy from the initial stage can increase recovery rates. Other innovations in the field include targeting genetic mutations in about 20% of patients, for whom biological treatments have been developed.

Overall, it's essential to know that there are now more treatment options for managing life with cancer. Some new therapies, such as radioactive treatments, allow for a good quality of life even in advanced and metastatic stages.

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