Prostate cancer remains the most common cancer diagnosed in Australian men, with an estimated more than a quarter of all new male cancer cases diagnosed in 2022.
Traditionally, prostate cancer has been diagnosed with both a PSA blood test and prostate biopsy under the guidance of ultrasound imaging to collect samples of tissue.
Scientists are uncovering more information about the genetic changes in prostate cancers, especially in men who also had relatives affected by prostate cancer, or by other cancers with an inherited element like breast or bowel cancer.
Various biomarkers and genetic tests have been developed to provide further clarity and assist in the counselling of family members of patients diagnosed with prostate cancer. In recent years, innovations in imaging technology have allowed for magnetic resonance imaging to be accepted as the new diagnostic standard in prostate cancer evaluation since it locates potential areas of suspected cancer within the gland and allows for more accurate prostate biopsy.
The prostate cancer grade is the most critical factor in determining the need for active interventions versus active surveillance. Active surveillance is an option for men who have a low risk of their cancer spreading, but this means intensive monitoring of cancer with regular biopsies and holding off on actual treatment unless there is evidence of progression with the view of curative intent when that time arrives, or the decision is made to switch to active treatments. Standard treatments for prostate cancer that have not spread elsewhere in the body are surgery or radiation therapy, with or without hormone therapy.
Scientific advances in robotic technology and various radiation modalities have significantly improved clinical outcomes and safety profiles for men undergoing radical surgery or radiation therapy. More recently, the introduction of newer drugs that target different molecular pathways in prostate cancer development and progression, such as androgen receptor blockers, checkpoint inhibitors and vaccines, have improved the survival rates of men with advanced prostate cancer unresponsive to traditional androgen deprivation (hormonal) therapy.
In addition to the use of PSMA (the same protein that is being tested for imaging prostate cancer) PET scan to detect cancer recurrence or metastatic disease, targeted therapies with radioactive compounds chemically linked to PSMA can potentially find, bind to, and kill prostate cancer cells throughout the body.
Given the chance of surviving prostate cancer has increased, greater emphasis is now placed upon cancer survivorship, and patients with prostate cancer receive more holistic and multi-disciplinary care with a focus on unmet needs to optimise quality-of-life and various aspects of prostate cancer care such as dietary supplements and healthy nutrition, physical exercise, psychological support, sexual rehabilitation, urinary care, health promotion and advocacy. While the outlook for men living with prostate cancer is getting encouraging, more research and funding are required to improve the detection and management of prostate cancer in men.