Prostate cancer treatment is a constantly evolving field. Researchers are continually developing new ways to diagnose and manage the disease. In recent years, there have been significant advances, leading to more precise techniques that target tumours while aiming to minimise side effects. This means that many men can now maintain a better quality of life during and after treatment. These advances include breakthroughs in understanding the genetic basis of prostate cancer, new focal therapy options, improved imaging techniques, and novel medications that target specific changes within prostate cancer cells. While early intervention can be beneficial for some prostate cancers, a personalised approach to treatment is key. 

Genetics

Advances in genetics have significantly improved our understanding of prostate cancer risk and how the disease behaves. Scientists have identified specific inherited gene mutations, such as in the BRCA1 and BRCA2 genes, that can increase the risk of developing aggressive prostate cancer. Genetic testing can help determine if a man carries these mutations, and this information can guide decisions about screening and treatment.

For men with a strong family history of prostate cancer, or those from certain ethnic backgrounds (for example, men of African or African-Caribbean descent), discussing genetic testing with a doctor may be beneficial.

By considering genetic markers alongside traditional factors like PSA levels and digital rectal examination (DRE) findings, doctors can build a clearer picture of an individual’s risk. Research in this area is ongoing, and it’s expected that genetic information will play an increasingly important role in identifying which men need closer monitoring or more intensive treatment. Genome Wide Association Studies (GWAS) are identifying more and more risk-associated SNPs (single nucleotide polymorphisms).

Prevention

While there’s no guaranteed way to prevent prostate cancer, adopting a healthy lifestyle may reduce the risk of developing aggressive disease. This may include:

  • Regular exercise: Staying physically active.
  • Balanced nutrition: Eating a diet rich in fruits, vegetables, and whole grains, and low in processed foods, red meat, and saturated fat.
  • Weight management: Maintaining a healthy weight.

Scientists are also investigating whether certain medications or dietary supplements might help prevent or delay prostate cancer in men at higher risk. However, there’s currently no definitive agreement on a specific “prostate cancer prevention diet.” For men with specific risk factors, discussing lifestyle changes with a healthcare provider is an important step.

Early Detection

Early detection aims to identify prostate cancer before it causes significant problems. While prostate cancer can often be asymptomatic for a long time, tools like the PSA (Prostate Specific Antigen) blood test and DRE can help doctors detect potential warning signs. Recent improvements in imaging, particularly multiparametric MRI (mpMRI), allow doctors to assess suspicious areas within the prostate more accurately and potentially avoid unnecessary biopsies.

Improved screening protocols and mpMRI have led to earlier diagnosis in many men, especially those at higher risk. If suspicious findings are detected, targeted biopsy techniques can help obtain tissue samples from the specific area of concern, leading to a more accurate diagnosis.

Diagnosis

If a man has a raised PSA level or an abnormal DRE, he may be referred for an mpMRI scan of the prostate. This detailed scan can highlight areas that are more likely to be cancerous, guiding the doctor to perform a targeted biopsy. Unlike older biopsy methods that sampled multiple areas of the prostate randomly, modern approaches use imaging guidance to biopsy only the most suspicious regions. This improves diagnostic accuracy and reduces the chance of missing significant tumours.

Further tests, such as bone scans, CT scans, or PET scans, may be used to determine if the cancer has spread beyond the prostate. Newer PET tracers, such as those targeting PSMA (prostate-specific membrane antigen), allow doctors to visualise small areas of spread that might not be detected with conventional imaging.

Staging

After diagnosis, staging assesses how far the cancer has advanced. The TNM system (Tumour, Nodes, Metastasis) and number staging (Stage 1-4) are still standard, but improvements in imaging mean that early spread can be detected more accurately. Molecular diagnostics also play a role, assessing the tumour’s genetic and molecular characteristics to help refine the staging. This helps doctors classify a patient’s risk level as low, intermediate, or high, which influences the treatment recommendations.

For example, if imaging and genetic tests confirm a localised tumour with features suggesting it’s slow-growing, active surveillance or focal therapy might be suitable. In contrast, a more aggressive tumour, or one that shows signs of spreading outside the prostate, may require a broader treatment approach, such as surgery or radiotherapy combined with hormone therapy.

Treatment

Recent years have seen a surge in new and refined treatments for prostate cancer at all stages. The choice of treatment depends on factors such as the cancer’s grade, stage, genetic markers, and the man’s overall health. Here’s an overview of some of the latest methods:

Active Surveillance

Active surveillance protocols are becoming more sophisticated, with greater use of mpMRI and targeted biopsies to monitor men with low-risk prostate cancer and identify those who may need definitive treatment.

Focal Therapy

Focal therapy is increasingly recognised as a valuable alternative to radical treatments (which treat the whole prostate) for men with localised prostate cancer. This approach targets only the areas of the prostate affected by cancer, sparing healthy tissue. Techniques under the focal therapy umbrella include:

  • High-Intensity Focused Ultrasound (HIFU): HIFU uses focused ultrasound waves to heat and destroy cancer cells within the prostate.
  • Cryotherapy: Freezes the cancerous tissue.
  • NanoKnife (Irreversible Electroporation, or IRE): NanoKnife uses electrical pulses to destroy cancer cells, aiming to preserve surrounding nerves and tissues.

By limiting treatment to the tumour area, focal therapy tends to preserve urinary continence and erectile function more effectively than removing or irradiating the entire gland. Ongoing research has shown promising results for carefully selected men, with many experiencing good control of localised disease and a lower risk of side effects. Regular follow-up is essential, as any remaining prostate tissue needs to be monitored for potential recurrence.


Prostatectomy

A prostatectomy is a surgical procedure to remove all or part of the prostate gland. It’s often used to treat prostate cancer confined to the prostate. The most common type is radical prostatectomy, which removes the entire prostate and some surrounding tissue. This surgery can be performed using different techniques, including open surgery, laparoscopic surgery, or robot-assisted surgery.

Potential side effects include urinary incontinence and erectile dysfunction, but nerve-sparing techniques aim to reduce these risks. The choice of treatment depends on various factors, including the patient’s overall health and the cancer’s characteristics.

Radiotherapy Advances

  • Stereotactic Body Radiotherapy (SBRT): SBRT delivers very high doses of radiation to the prostate in a small number of treatment sessions (typically 1-5). It’s becoming increasingly common and offers similar outcomes to longer courses of conventional radiotherapy.
  • Proton Therapy: Proton therapy is a type of radiation that can be more precisely targeted to the prostate.
  • Brachytherapy: Radioactive seeds are implanted.

Hormone Therapy Advances

  • Newer hormone therapy drugs, such as abiraterone, enzalutamide, and apalutamide, are more potent and have shown significant benefits in men with advanced prostate cancer.
  • Research is also exploring the use of hormone therapy in combination with other treatments.

Targeted Therapies

PARP inhibitors, such as olaparib and rucaparib, are approved for men with metastatic castration-resistant prostate cancer who have mutations in certain DNA repair genes (e.g. BRCA1, BRCA2). These drugs prevent cancer cells from repairing DNA damage, slowing or stopping tumour growth.

Immunotherapy

Immunotherapy harnesses the body’s immune system to attack cancer cells. While it has transformed treatments for some cancers, its role in prostate cancer is still developing. One approach, sipuleucel-T, involves taking a patient’s immune cells, modifying them in a laboratory to recognise prostate cancer cells, and then reinfusing them. This method has shown some benefit in men with advanced disease, though further research is needed.

Radiopharmaceuticals

  • Lutetium-177 PSMA: This is a radiopharmaceutical that targets prostate-specific membrane antigen (PSMA). It delivers radiation directly to the cancer cells.

Combination Approaches

As knowledge of prostate cancer biology grows, doctors are increasingly using combination treatments tailored to an individual’s tumour profile. Patients might receive surgery or radiotherapy in conjunction with advanced hormone agents, or perhaps immunotherapy paired with radiation.

Frequently Asked Questions

What is the latest treatment for prostate cancer?

There isn’t one single “latest” treatment, as research is constantly advancing. Recent developments include refined focal therapies like HIFU and NanoKnife, newer hormone therapy drugs (abiraterone, enzalutamide, apalutamide), PARP inhibitors for men with specific gene mutations, radiopharmaceuticals like Lutetium-177 PSMA, and ongoing research into immunotherapy. The best treatment depends on the individual’s specific situation.

What is the most successful prostate cancer treatment?

There’s no single “most successful” treatment for all cases. Success depends on the cancer’s stage and grade, the man’s overall health, and his personal preferences. For localised prostate cancer, options like active surveillance, surgery, radiotherapy, and focal therapy can all be very effective. For advanced prostate cancer, hormone therapy, chemotherapy, radiopharmaceuticals, and targeted therapies can extend life and improve quality of life. Patients can also explore patient stories to learn about real experiences with different treatment approaches.

 

References

  1. Cancer Research UK. (n.d.). Prostate cancer treatment. Retrieved from https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment
  2. Prostate Cancer UK. (n.d.). Treatments for prostate cancer. Retrieved from https://prostatecanceruk.org/prostate-information/treatments
  3. European Association of Urology. (2023). EAU Guidelines: Prostate Cancer. Retrieved from https://uroweb.org/guidelines/prostate-cancer

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