Technologies That Enable Living Alongside Prostate Cancer

Prostate cancer is the most common malignant tumor among men in Israel and the Western world, with about 2,500 new patients diagnosed in Israel each year, and its incidence increases with age. The prostate gland is located at the base of the bladder and plays an important role in male fertility. Sometimes, urinary obstruction can be an initial symptom.

Many studies have been conducted in recent years to understand its causes, but as the disease affects all subpopulations and significant risk factors are unknown, except for hereditary family risk, there is still no definitive understanding, and causes are only partially known.

Most patients are diagnosed following an increase in PSA levels in the blood, which is a protein also secreted by benign prostate cells, but to this day, there is significant debate worldwide on whether screening tests should be conducted for men over 50. Although the evidence is not conclusive, there is indirect evidence suggesting that in countries where more screening tests are performed, mortality decreases.

The reason for the debate is that such tests can sometimes detect very slow-growing prostate cancers that one can live with, and their detection, or in other words "over-diagnosis," can lead people to receive unnecessary treatments. However, even though periodic screenings are not conducted, it is advisable and important to know and to request it from doctors because early detection can save lives.

Treatments That Changed the Picture

After detecting high PSA levels in the blood, diagnosis continues with an MRI of the prostate, and then a targeted biopsy. If cancer is detected, a full body investigation is done to identify metastases, and only then is the treatment decision made.

In recent years, due to improved diagnostic and treatment methods, and the ability to classify and differentiate between different cancer subtypes and tailor treatments more specifically, recovery chances for this cancer stand at over 90%, and the course of treatment is determined based on risk level and the presence of metastases, if any.

At higher risk levels, a treatment decision includes, among other things, surgery or radiation therapy. In some cases, the decision might be to perform radiation combined with hormone therapy to reduce testosterone, the growth hormone of prostate cancer cells, thereby "starving them," but usually, it's only a matter of time before the tumor develops resistance to this state.

Thanks to many breakthroughs recently seen in the field, there are also other advanced treatments intended for situations where hormone therapy is no longer effective. One of the major innovations in recent years are the radioactive treatments that create local and internal radiation on all diseased areas.

Due to the binding of the substance to the cancer cells and the ability to reach all parts of the body, this treatment is very effective, alleviates pain, can significantly reduce metastases, and has been proven to extend life with few side effects. Although it is not part of the health services package in Israel, it is currently available and subsidized for those with private insurance.

In recent years, it was also understood that if additional treatment is given to the patient at the initial stage beyond the basic hormone therapy, the chances of recovery increase. More innovations in this field are also related to mutations in relevant genes for about 20% of patients, for whom biological drugs have been developed.

Overall, it's important to know that there are now more treatment line options, more ways to manage life with cancer, and in some of the new treatments like radioactive treatments, it's even possible to live a good quality of life even in the advanced and metastatic stages of the disease.

The author is the director of the urological oncology unit at Beilinson Hospital.