Reason for Optimism about Prostate Cancer in Today’s World
By Dr. Dan Sperling
Did you know? According to a very recent review of the global prostate cancer picture, prostate cancer is the most common non-skin cancer affecting men in the United States. Current estimates reveal that almost 300,000 new cases and over 35,000 deaths may occur in 2026. Globally, prostate cancer ranks as the second most common cancer in men, affecting about 1.5 million men annually. Compared with other cancers that affect either men or women, these are sobering numbers.
This disease typically affects older men, with the average age at diagnosis being 67 years. Research trends show that a growing number of younger men are being diagnosed with the disease, though explanations vary. Compared to White men in general, however, Black men face a significantly higher risk, with about 1 man out of about 578 developing prostate cancer vs. 1 out of 1030 White men. While there are different theories about why this occurs in the U.S., two main theories are either 1) genetics, or 2) social and economic disparities in healthcare. The first points to biology, while the second points to inferior services among minorities or economically disadvantaged communities. At this time, the explanation is unknown but under much study.
What we do know, however, is a definite link between family history and the probability of developing this disease. More than half of prostate cancer risk comes from genetic factors passed down through families. Looked at another way, a man with a first degree relative (father, son, brother) who has prostate cancer has a 50% chance of getting it. And, here’s something important many men and women don’t know. If a first degree relative (mother, daughter, sister) has breast cancer, a high-risk genetic link between these two cancers has been found. Men who carry either of the two most prevalent breast cancer genes (BRCA1 and BRCA2) have more risk for prostate cancer.
How do we know this? Research shows that a significant number of men with prostate cancer have either of those genes more often than men who do not have prostate cancer. It is therefore recommended that if a man is diagnosed with prostate cancer, he has a genomic analysis to see if he’s a carrier of either of these gene variants. If so, experts recommend that he inform any daughters that they may want to be tested to see if they are at greater risk of breast cancer. Likewise, breast cancer patients who carry either gene should consider advising their adult sons to undergo genetic testing—because if they carry a BRCA gene they have more chance of developing prostate cancer.
On a happier note, about 75% of prostate cancer cases are caught while the cancer is still confined to the prostate gland (localized prostate cancer). When found at this early stage, the five-year survival rate is nearly 100%. For men with lower-risk prostate cancer, doctors often recommend “active surveillance” rather than immediate treatment. This approach involves regular blood tests, imaging, and biopsies to monitor the cancer, with treatment starting only if the cancer shows signs of becoming more aggressive. In fact, studies show that men on Active Surveillance who also convert to healthy non-inflammatory diets and commit to regular vigorous exercise reduce their chances of increased tumor activity.
For higher-risk cases, the traditional treatment options include surgery to remove the prostate (radical prostatectomy) or radiation therapy to the whole gland. These “take no prisoners” approaches to eradicating the cancer are highly effective, which is the upside. If there’s a downside, it’s the risk of urinary, sexual or bowel side effects. These occur because the prostate gland is positioned where it’s rather intimately connected with urination (the urethra, or outlet from the bladder to the penis passes through the gland), sexual function (the nerve and blood vessels that control erection “hug” the prostate gland), and the gland sits in front of the rectal wall. Thus, removing or radiating the gland can cause collateral damage.
The high success rate for treating localized prostate cancer is good reason for optimism. There’s an additional reason for men newly diagnosed with cancer still contained in the gland. However, as mentioned earlier, younger men in their 50s and even 40s are being found with prostate cancer. Since the majority of younger patients are still working and have active sex lives, they are often conflicted about undergoing treatment. They want the cancer destroyed, but they are anxious at the thought of urinary leakage or erectile dysfunction.
Thankfully, today there is a middle ground between Active Surveillance, which delays treatment until triggered by an uptick in the cancer’s activity, and more aggressive whole-gland treatments like prostatectomy or radiation. It’s called “focal therapy.” This means that, depending on factors like the cancer risk level, the tumor location and size, and the ability to see the tumor on an MRI scan, it’s possible to precisely destroy just the tumor while preserving health gland tissue. For the right patient, focal treatment can avoid damaging the urethra, spare the nerve/blood vessel bundles next to the gland that control erections, and are nowhere near the bowel—so there’s minimal risks of side effects. For example, Focal Laser Ablation guided by real-time MRI uses a laser fiber inserted into the tumor to ablate (destroy) the tumor with intense heat. During treatment, MRI is used to monitor the zone and temperature of the procedure, and afterward it confirms the zone of destruction. This is just one method out of several, but it illustrates how focal therapy works.
One important note: Patients who are considering Active Surveillance or focal therapy must undergo compete diagnostics to make sure they are candidates. This includes PSA blood test, a special prostate MRI called multiparametric MRI, biopsy results, possible genomic tests, and an honest discussion with their doctor about their life and lifestyle. No responsible doctor willingly agrees to a treatment strategy that will leave a high-risk tumor untreated in a patient’s body. The good news is, today’s prostate cancer services equip doctors and patients to know all the clinical details that enable tailoring treatment to each patient’s unique combination of clinical characteristics and lifestyle preferences.
With all this in mind, there’s no excuse for men to skip an annual PSA exam. The earlier prostate cancer is detected, the more treatment strategies there are with the highest possible success rates. And that’s reason for optimism about prostate cancer today.
