Prostate Knowledge Archive

Abnormal results on a prostate-specific antigen (PSA) screening test for cancer are typically followed by a systematic biopsy. But systematic biopsies can be problematic, and researchers are seeking alternatives. A large European study provides encouraging evidence favoring a different approach that uses MRI instead of biopsy.

Men with high prostate-specific antigen (PSA) levels often get a biopsy of prostate tissue to check for cancer. The results of the biopsy are calculated to create a Gleason score, which helps doctors assess whether the cancer is low-, medium-, or high-risk. Based on that information, doctors may recommend that a man follow active surveillance (in which he monitors his PSA for changes) or begin cancer treatment.

The specialized cells of our immune systems help to keep us healthy and free of infectious diseases. Immunotherapies teach those same cells to recognize and destroy cancer. Researchers are reporting promising results with a different method that involves engineered cells studded with receptors that bind to specific targets on cancer cells.

A 2024 study found that a urine test that looks for cancer genes may help identify the most serious cases of prostate cancer among men with high levels of prostate-specific antigen (PSA). This could help many men with high PSA levels avoid biopsies.

Artificial intelligence (A.I.) has made significant strides in helping doctors better diagnose and treat prostate cancer. A.I. uses mainly software programs that apply complex computational algorithms to improve precision and efficiency in diagnosis, treatment, and management. Three areas where A.I. will likely have the most impact are examining prostate biopsies with greater insight, finding hard-to-see tumors on MRI images, and determining which men undergoing radiation may also benefit from androgen deprivation therapy.

Androgen deprivation therapy can slow or control prostate cancer, and adding a second class of drugs improves survival when the disease is in advanced stages. But all drugs that block testosterone have challenging side effects, and a review of studies showed that cardiovascular risks worsen when these drugs are given together.

When cancer patients are treated with radiation, it's possible that the therapy itself may cause new tumors to form in the body later. Canadian researchers published findings in 2014 finding no difference between groups of men treated with cancer or with surgery — but following up another decade later, there was a clear increase in risk.

Active surveillance (AS) is the most common choice for men facing a diagnosis of low-risk prostate cancer, in which the tumor is confined to the prostate gland and unlikely to grow or spread. Men can potentially continue AS indefinitely until their condition changes. There are situations in which they should move to treatment because the cancer has become more aggressive. Or they may be ready to stop if there has been no cancer progression or they no longer wish to continue with the regular monitoring and testing of AS.

When a PSA test produces an abnormal result, the next step is usually a prostate biopsy, but these have drawbacks. Researchers are exploring strategies to avoid unnecessary biopsies, and a test that screens for prostate cancer in urine samples has shown promising results in testing.

A 2023 study confirms prior research showing that men with low testosterone levels who use testosterone replacement therapy for 14 months are not at a higher risk for prostate cancer over the following several years.