Prostate cancer treatment is highly individualized, based mainly on the cancer’s stage, Grade Group/Gleason score, PSA level, imaging findings, age, overall health and patient preferences.
Treatment options by disease category
| Disease category | Main treatment options | Advanced technologies |
|---|---|---|
| Very low / Low risk | Active surveillance; selected patients may undergo definitive treatment | MRI-based surveillance, targeted biopsy, AI-assisted imaging |
| Intermediate risk | Robotic radical prostatectomy or radiation therapy ± short-term hormone therapy | Robotic/single-port surgery, MRI-guided radiotherapy, PSMA-PET imaging |
| High / Very-high risk | Surgery in selected patients; radiotherapy + androgen-deprivation therapy (ADT), often with treatment intensification | PSMA-PET staging, image-guided radiotherapy, advanced robotic surgery |
| Localized disease – selected patients | Focal therapy may be considered in carefully selected cases | HIFU, TULSA and other precision focal therapies |
| Metastatic hormone-sensitive cancer | ADT + androgen-receptor pathway inhibitor and/or chemotherapy, depending on disease characteristics | PSMA-PET-guided staging and precision treatment |
| Metastatic castration-resistant cancer | AR-targeted therapy, chemotherapy, radioligand therapy, immunotherapy or other targeted treatments according to biomarkers and prior treatment | PSMA radioligand therapy, genomic/biomarker-guided treatment |
Key innovations in modern prostate cancer care
- PSMA-PET/CT or PET/MRI — highly sensitive molecular imaging that can improve staging and detection of recurrent/metastatic disease.
- Multiparametric MRI + targeted/fusion biopsy — improves identification and sampling of clinically significant prostate cancer.
- Robotic-assisted radical prostatectomy — minimally invasive surgery designed to achieve cancer control while attempting to preserve urinary continence and erectile function when oncologically appropriate.
- Precision radiation therapy — modern image-guided and stereotactic techniques can deliver radiation more precisely while limiting exposure to surrounding tissues.
- Focal therapy — HIFU and TULSA are being used in selected localized cancers, although they are not appropriate for every patient and have a more limited evidence base than established surgery/radiotherapy.
- PSMA-targeted radioligand therapy — an important newer treatment for appropriately selected advanced/metastatic PSMA-positive prostate cancer.
- Precision oncology — genomic testing can identify actionable alterations, such as DNA-repair pathway abnormalities, and help guide systemic therapy in advanced disease.
Ideal Prostate Cancer Center of Excellence
A comprehensive center should provide a multidisciplinary pathway:
PSA → Multiparametric MRI → MRI-targeted biopsy → Histopathology/Grade Group → PSMA-PET when indicated → Multidisciplinary tumor board → Personalized treatment → Functional rehabilitation & surveillance.