Prostate cancer develops in the prostate gland, part of the male reproductive system responsible for producing seminal fluid. It is the most common cancer in men, especially those over 50. In most cases, it grows slowly and does not require immediate intervention, but it can occasionally become aggressive. The main challenge is to detect it early and, in certain cases, to treat it appropriately. Adenocarcinoma is the most common type (about 95% of cases).
Main risk factors:
Advanced age (especially over 50), family history (BRCA1/2, HOXB13 gene mutations), African-American ethnicity, a diet high in saturated fats, obesity, and high levels of male sex hormones (testosterone).
Diagnosis is performed through blood testing for PSA (Prostate-Specific Antigen), a digital rectal examination (DRE), MRI of the prostate, and a targeted biopsy based on MRI findings. For certain types and stages with potential for spread, a PSMA-based PET/CT scan is performed to determine the extent of disease.
The main goal is to identify the type and stage of cancer and decide whether and how to treat it. Treatment is tailored to the patient’s age, overall health, and disease characteristics. Generally:
• Low- or very low-risk disease: Active Surveillance.
• Intermediate-risk disease: Radical prostatectomy (often performed robotically using the Da Vinci system) or external radiation therapy.
• High-risk disease: approaches vary between radical prostatectomy, external radiation combined with hormonal therapy, or a combination of both.
• Advanced/metastatic disease: hormonal therapy, chemotherapy, or combinations with advanced hormonal therapies. In cases with bone metastases, isotopic treatments such as Radium-223 or Lutetium-177 (177Lu-PSMA) are used to target cancer cells.
Innovative treatments include immunotherapy—personalized or general—and targeted therapies for patients with BRCA gene mutations.
It is important to note that survival rates depend on the cancer type, stage, and PSA levels at diagnosis. However, early detection and advanced treatments significantly improve recovery prospects.
Prof. Nicola Mabjeesh
Head of the Urology Department
Soroka University Medical Center
