Prostate Cancer Update: The Latest Treatments


Have you or someone you love been diagnosed with high PSA levels? Elevated PSA levels sometimes indicate prostate cancer, but not always. Sometimes those levels are spiking in response to inflammation or another health condition. Generally, a PSA test reveals that a man’s prostate—the small gland under the bladder that affects urine control and semen production—is producing higher-than-normal levels of its signature protein, prostate-specific antigen or PSA.

Your PSA score, along with a prostate biopsy and imaging, helps your urologist determine if prostate cancer is your diagnosis. These also help him determine your best treatment options based on how aggressive and fast-growing the cancer is. Here we discuss the traditional treatment approaches you may be familiar with, as well as the latest prostate cancer treatments available.

Getting a Prostate Cancer Diagnosis

Receiving a prostate cancer diagnosis can be upsetting, to say the least, but today there are many effective treatment options available. It is estimated that 33 out of 34 men diagnosed will survive prostate cancer. Prostate cancer is the most common type of cancer in men and is curable if diagnosed very early. While it is curable when caught early, some prostate cancer treatments can help manage the disease at later stages by slowing its growth or preventing it from spreading (metastasis) beyond the prostate.

Therapies aimed at treating advanced prostate cancer are critical because many men are not diagnosed until after it has spread. News reports from the United Kingdom reveal that four in 10 cases of prostate cancer in the UK are diagnosed late—roughly 25% of prostate cancer cases there are diagnosed at advanced stages of metastasis, leading to treatment challenges. Delayed referrals and unreliable cancer screenings have contributed to this problem in the UK, where efforts are being undertaken to raise public awareness and improve screening methods.

In the US, where there is greater awareness of the need for early and regular PSA tests and other screenings, only 8% of prostate cancer cases are diagnosed at later stages. The aim when treating late-stage prostate cancer is preventing it from spreading, particularly to the bones.

New Advances in Prostate Cancer Treatment

While many longstanding treatment approaches are still considered effective, prostate cancer research has delivered advances in prostate cancer treatment options that can better manage the disease. Depending on your PSA level and stage of cancer, treatment may involve:

Active Surveillance (Watching and Waiting). If you are diagnosed with localized prostate cancer that is slow-growing, your urologist may recommend active surveillance—with regular testing (PSA, biopsies and scans). Supportive treatment interventions, such as exercise and dietary changes, may also be beneficial. Depending on their age and overall health, many men with slow-growing prostate cancer can outlive the disease before it causes symptoms or develops metastases.

Hormone therapy, or androgen deprivation therapy (ADT). Hormonal therapy can slow the growth of prostate cancer cells, controlling it for many years in some men. In those patients whose cancer has already spread (metastatic disease), ADT is effective for a shorter period—roughly 18-24 months. After that, the cancer becomes resistant to hormone treatment, and these patients are considered “castration resistant.” Chemotherapy drugs may be recommended as the next step in treatment.

Chemotherapy. Several medications are approved for use in prostate cancer patients, and these are indicated for men whose cancer has spread (metastasized) or become castrate resistant. For those patients with “distant metastases” who are eligible to receive these drugs, the medications can extend their life with the disease. These prostate cancer chemo drugs include Xtandi® (enzalutamide) and Xofigo (radium 223 dichloride).

On the horizon are FDA approvals and availability of other drugs that may deliver even better outcomes. In 2017, the drug Zytiga® (abiraterone) combined with hormone therapy for prostate cancer was found in clinical trials to double life expectancy in patients with the most advanced form of the disease.

Another drug, Erleada™ (apalutamide), was recently tested in a trial involving 1,200 men across 23 countries with non-metastatic, castration-resistant prostate cancer. Their disease no longer responded to ADT, and their elevated PSA levels indicated the cancer might spread. Erleada™, which blocks the testosterone receptor, successfully slowed cancer cell growth, giving trial participants at least two additional years of progression-free life before their prostate tumors spread.

Radiotherapy. Intended for earlier stages of prostate cancer, a commonly used form of radiotherapy is external beam radiotherapy (EBRT), which involves focusing beams of radiation on the prostate gland from a machine outside the body—almost daily for several weeks. Brachytherapy is an internal form of radiotherapy that involves the implantation of radioactive seeds into the prostate.

High-intensity focused ultrasound, or HIFU. A non-invasive option for men with recurrent prostate cancer, HIFU for prostate cancer treatment involves using technology such as Sonablate® for delivering precisely focused ultrasound waves. HIFU may be recommended if you are no longer a candidate for radiation therapy or surgery to remove the prostate.

Cryotherapy or cryoablation. This therapy uses extremely cold temperatures to freeze and destroy cancer tissue in the prostate, causing cancer cells to die. Although it is sometimes called “cryosurgery,” this is not a surgical procedure. This is a minimally invasive alternative approach whereby the urologist anesthetizes the area and uses ultrasound for guidance as he places ultrathin metal tubes or needles into the prostate to freeze the cancerous tissue. This treatment is most commonly used for patients who experience a recurrence of prostate cancer after radiotherapy.

Prostate cancer surgery, or prostatectomy. Both localized and advanced or aggressive prostate cancer may be treated using radical prostatectomy, which involves surgically removing the prostate and any surrounding tissue that has been affected. Your urologist may recommend minimally invasive robotic radical prostatectomy using the da Vinci® Surgical System—the most advanced in robotics technology—to provide you with the next evolution in prostate cancer treatment. As compared to other surgical treatments, a da Vinci robotic prostatectomy can deliver greater precision in removal of the cancerous tissue. This translates to a higher rate of cancer control, as measured by the number of cancer cells left behind. It also offers lower rates of urinary incontinence and erectile dysfunction. Further, because robotic prostatectomy results in less tissue damage compared to traditional prostatectomy, the recovery rate is faster.

This article was medically reviewed by Thomas Ahlering, MD, and James Porter, MD, as part of miVIP’s Healthy Living Recommendations.


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PUBLISHED 29 May, 2018

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