Reading time: 12 minutes
Author: Focal Therapy Medical Team
Medically reviewed by Dr Christos Mikropolous FRCR GMC 4692210
Published: Jan 02 2026
Targeted therapy represents a significant shift in how we treat cancer. Unlike traditional chemotherapy, which can affect both healthy and cancerous cells, targeted drugs are designed to identify and attack specific genetic or molecular features of the cancer cells.
In 2026, the landscape of prostate cancer care has evolved. While treatments like surgery and hormone therapy remain foundational, advances in latest treatment options focus on precision. These therapies look at the unique “engine” driving a specific tumour, such as a genetic mutation or a specific protein on the cell surface, and aim to switch it off. For men with advanced or aggressive disease, this approach offers a way to potentially control the cancer more effectively while attempting to preserve quality of life.
Key Takeaways
- Targeted therapies for prostate cancer, such as PARP inhibitors and PSMA-targeted radioligands, offer precision treatment by focusing on specific genetic or molecular features of cancer cells.
- PARP inhibitors like Olaparib and Rucaparib are especially effective for men with DNA repair gene defects, such as BRCA1 or BRCA2.
- PSMA-targeted radioligand therapy, such as Pluvicto®, delivers radiation directly to cancer cells throughout the body, sparing healthy tissue.
- Emerging therapies, including PROTACs and bispecific antibodies are under investigation to address drug resistance.
- Genetic and molecular testing is essential to determine patient eligibility for targeted therapies.
- The Focal Therapy Clinic integrates these systemic options into a broader management plan, alongside minimally invasive local treatments.
Types of targeted therapy drugs for prostate cancer
Targeted drugs work by interfering with specific molecules that cancer cells need to grow, divide, and spread. The primary categories of targeted therapy approved or in advanced development for prostate cancer include:
- PARP inhibitors: Drugs that stop cancer cells from repairing their damaged DNA.
- PSMA-targeted radioligands: Therapies that attach radioactive atoms to specific cancer cell targets.
- Emerging agents: New classes of drugs designed to overcome resistance to standard treatments.
| Drug class | Examples | How it works | Typical patient profile |
| PARP Inhibitors | Olaparib, Rucaparib, Talazoparib | Blocks the repair of DNA in cancer cells, causing them to die | Men with BRCA or ATM gene mutations |
| PSMA Radioligands | Pluvicto® (Lutetium-177) | Deliver radiation directly to PSMA-expressing cells | Men with advanced cancer that has spread (metastatic) |
| Emerging Agents | PROTACs, Bispecific antibodies | Degrade cancer proteins or engages the immune system | Experimental, overcoming resistance |
PARP inhibitors and their role
PARP inhibitors block cancer cells’ DNA repair mechanisms, causing cell death in tumours with existing genetic repair defects like BRCA mutations. Drugs such as Oleparib and Rucaparib are now standard options for men with specific genetic profiles, often used when hormonal therapies have stopped working.
PARP Inhibitors are being combined with other treatment options to improve outcomes earlier in the disease course than before.
PSMA-targeted radioligand therapies
Prostate-Specific Membrane Antigen (PSMA) is a protein found in high amounts on the surface of most prostate cancer cells. PSMA-targeted therapy uses a specialised molecule to “dock” onto this protein, delivering a radioactive payload directly into the cell.
The leading therapy in this class involves Lutetium-177. Studies have shown that for suitable patients, this approach can reduce PSA levels and slow disease progression. Because it targets the cancer cells specifically, it aims to limit damage to surrounding healthy organs compared to external beam radiation. Determining eligibility requires a specific PSMA-PET scan to “map” the disease.
Emerging targeted agents
Science moves quickly. Researchers are currently investigating “PROTACs” (Proteolysis Targeting Chimeras), which are designed to break down cancer-driving proteins completely rather than just blocking them.
Additionally, bispecific antibodies, drugs that connect immune cells directly to tumour cells, are showing promise in early studies.
While many of these are still in the research phase, they offer potential future avenues for men whose cancer has become resistant to standard therapies.
The Focal Therapy Clinic’s approach to targeted prostate cancer treatment
At The Focal Therapy Clinic, our primary expertise lies in treating localised disease with precision, using focal therapy technologies like Nanoknife (IRE) (NICE IPG768) and HIFU (NICE IPG424) . However, we view prostate cancer care as a journey that may require different tools at different times.
For patients with localised disease, we use advanced diagnostics to ensure medical suitability for focal treatment, preserving tissue and function. For patients who present with or progress to advanced prostate cancer, we collaborate with medical oncologists to integrate systemic targeted therapies into the care plan. We ensure that every patient has access to the most appropriate technology, whether that is a physical ablation of a tumour or a molecular drug to treat systemic disease.
Selecting the right targeted therapy
There is no single best treatment for prostate cancer, selected therapy depends on stage, grade, disease spread, health, and patient preference. Treatment decisions are highly individualised, balancing clinical factors and patient goals, including whether systemic treatment or choosing focal therapy is the most appropriate first step.
A decision-making flow or checklist can help patients and clinicians discuss options, considering:
- Genetics: Does the tumour have a BRCA mutation?
- Imaging: Is the cancer visible on a PSMA PET scan?
- Previous treatment: What has the patient already tried?
- Overall health: Can the patient tolerate potential side effects?
The Focal Therapy Clinic follows NCCN guidelines and latest research to provide tailored consultations, ensuring patients receive the most appropriate targeted therapy.
Key factors in treatment selection
Several clinical and personal factors influence the choice of targeted therapy for prostate cancer. Understanding these variables helps tailor treatment plans to achieve the best possible outcomes while respecting patient preferences and medical suitability.
| Factor | Impact on decision | Example |
| Metastatic status | Spread to bones / nodes often requires systemic drugs | Lutetium-177 for widespread PSMA-positive spots |
| Genetic profile | Mutations determine drug compatibility | BRCA2 positive patients are candidates for PARP inhibitors |
| Prior therapies | Resistance to hormones may trigger a switch | Moving to targeted drugs after enzalutamide or abiraterone |
| Localisation | Confined to the prostate | Suited for focal therapy (e.g. HIFU / NanoKnife (IRE)) |
Genetic and molecular testing for personalised therapy
Genetic and molecular testing analyses tumour or blood samples for mutations (such as BRCA, ATM, i.e. DNA-repair genes), guiding selection of targeted therapies. These tests identify patients most likely to benefit from PARP inhibitors or other precision drugs.
Recommended panels assess DNA repair gene status and other biomarkers. Our multidisciplinary team, led by GMC-registered consultants, integrates genetic test results into personalised treatment plans ensuring patients understand all available options.
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Combining targeted therapy with other treatment modalities
Combination therapy can yield better outcomes and is increasingly recommended for complex or advanced prostate cancer cases. Targeted therapies are often used alongside hormone therapy, chemotherapy, or focal therapy depending on disease specifics.
Current guidelines increasingly support “combination strategies.” For example, using a PARP inhibitor together with a hormonal drug may keep the cancer under control for longer than using either drug alone. Our multidisciplinary team, including urologists and oncologists, reviews these combinations to balance efficacy with the patient’s lifestyle and tolerance.
Benefits and potential side effects of targeted therapies
While targeted therapies offer significant advantages in precision and effectiveness, they are not without side effects. It is important to be realistic about the trade-offs.
- PARP inhibitors: Common issues can include fatigue, nausea, and changes in blood counts (anaemia).
- PSMA radioligands: Can sometimes cause dry mouth, fatigue, or temporary changes in blood cell production.
However, for many men, these side effects are manageable and often less severe than traditional chemotherapy. Monitoring is key to maintaining quality of life during treatment.
Advances driving the future of prostate cancer targeted therapy
The future of care is data-driven. Artificial Intelligence (AI) is beginning to play a role in how we interpret scans and genetic reports, helping us predict which patient will respond best to which drug.
At The Focal Therapy Clinic, we utilise AI-enhanced imaging for accurate diagnosis and staging. As we move through 2026, the integration of real-world patient data helps refine these predictive models, ensuring that treatment decisions are based on the latest evidence.
Ongoing clinical trials and research
Active clinical trials are testing new agents such as Pluvicto in earlier disease stages, bispecific antibodies, and novel PROTACs. Eligibility criteria vary, and phase I/II trials demonstrate promising PSA declines and survival improvements.
The Focal Therapy Clinic provides resources and guidance for patients interested in trial participation, ensuring access to cutting-edge therapies.
Frequently asked questions
The most prominent therapies include PARP inhibitors for specific genetic mutations and PSMA targeted radioligands such as Lutetium 177. Emerging options, including PROTACs, are also being investigated in clinical trials.
Traditional chemotherapy attacks all rapidly dividing cells and often causes widespread side effects. Targeted therapies focus on specific molecular defects within the cancer cell, aiming to be more effective while sparing healthy tissue.
Eligibility typically depends on genetic and molecular tumour testing that identifies mutations or biomarkers suited to these drugs. This may include genetic testing for DNA repair mutations or a PSMA PET scan to confirm expression of the PSMA protein.
Side effects vary by drug, but targeted therapies generally cause fewer overall side effects than chemotherapy. Some may cause fatigue, changes in blood counts, or mild radiation related effects. Your medical team will monitor your vitals and blood tests regularly to manage these.
Yes. It is increasingly standard practice to combine targeted therapies with hormone treatment to attack the cancer from multiple angles at the same time.
References
Clarke, Noel W et al. “Abiraterone and Olaparib for Metastatic Castration-Resistant Prostate Cancer.” NEJM evidence vol. 1,9 (2022): EVIDoa2200043. doi:10.1056/EVIDoa2200043
Sartor, Oliver et al. “Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer.” The New England journal of medicine vol. 385,12 (2021): 1091-1103. doi:10.1056/NEJMoa2107322
Mateo, Joaquin et al. “DNA Repair in Prostate Cancer: Biology and Clinical Implications.” European urologyvol. 71,3 (2017): 417-425. doi:10.1016/j.eururo.2016.08.037
European Association of Urology (EAU) (2026). Guidelines on Prostate Cancer. Arnhem: EAU Guidelines Office.
