Prostate Cancer What's new and What's coming by Dr. Fred Saad, CQ, MD, FRCS, FCAHS, Professor and Chairman of the Department of Surgery at the University de Montreal, Holder of the Raymond Garneau Chair in Prostate Cancer Research, Director of GU Oncology and Clinical Research as well as the Molecular Oncology Research Laboratory in Prostate Cancer

New Prostate Cancer Treatments: What Every Man Should Know in 2025​

If you've been diagnosed with prostate cancer or are worried about your prostate health, you're probably feeling overwhelmed by all the medical information out there. The good news? There are more treatment options available today than ever before, and doctors are getting smarter about who actually needs treatment and who doesn't.


This guide breaks down the latest research on prostate cancer treatment in plain English. We'll walk you through everything from early detection to advanced therapies, so you can have better conversations with your doctor about what's right for you.

What Is Prostate Cancer and Why Does It Matter?​

Prostate cancer happens when cells in your prostate gland start growing out of control. Your prostate is a small gland about the size of a walnut that sits below your bladder. It's part of your reproductive system.


Here's the thing: not all prostate cancer is the same. Some types grow very slowly and might never cause problems in your lifetime. Other types are more aggressive and need treatment right away. The challenge for doctors is figuring out which is which.

Smarter Screening: Using MRI to Avoid Unnecessary Biopsies​

One of the biggest breakthroughs in prostate health is how we're using MRI scans to screen for cancer. A recent study from Sweden looked at over 13,000 men who got both PSA tests and MRI scans over four years.

What the Research Shows​

The results were impressive. When doctors used MRI along with PSA testing, they were able to:

• Reduce unnecessary biopsies by about 50%
• Avoid finding insignificant cancers that didn't need treatment
• Still catch the dangerous cancers that required attention

What this means for you: If your PSA is slightly elevated, your doctor might recommend an MRI before doing a biopsy. This approach helps avoid the stress, cost, and potential side effects of a biopsy when it's not really needed.


The risk of missing a serious cancer with this approach is very low. Think of the MRI as an extra layer of protection that helps doctors make smarter decisions about who needs a biopsy and who can safely avoid one.

After Surgery: When Do You Really Need Radiation Therapy?​

If you've had surgery to remove your prostate and your PSA levels start rising again, you might need radiation therapy. But when should that happen, and do you need hormone therapy along with it?

The RADICALS Study: Important Findings​

A major study called RADICALS, which included thousands of patients, looked at these exact questions. Here's what they found:


Timing matters: Doctors used to give radiation immediately after surgery to high-risk patients. But the research showed that waiting until your PSA rises slightly (above 0.1) works just as well. You don't need immediate radiation therapy if your PSA stays low after surgery.


Hormone therapy isn't always necessary: The study compared men who got hormone therapy (called ADT) with their radiation versus those who got radiation alone. Surprisingly, for many men, there wasn't a big difference in outcomes.


However, if you're at high risk or your PSA has risen pretty high (above 0.5 or higher), you'll probably benefit from adding hormone therapy to your radiation treatment.

How Long Should Hormone Therapy Last?​

If you do need hormone therapy with radiation, how long should you take it? The research showed:

• Short-term hormone therapy (6 months) might not be enough for high-risk patients
• Longer treatment (24 months) showed better results for men with aggressive cancer
• If you catch things early with a low PSA, you might not need much hormone therapy at all

The bottom line: If you need radiation therapy after surgery, the earlier you start when your PSA is still low, the less hormone therapy you'll likely need. Don't wait until your PSA climbs too high.

PSMA PET Scans: A Game-Changer for Finding Cancer​

PSMA PET scans are a newer type of imaging that can find prostate cancer cells throughout your body with incredible accuracy. They're much more sensitive than older CT or bone scans.

The PATRON Study: Does Finding More Disease Help?​

A groundbreaking Canadian study called PATRON asked an important question: if we can find cancer earlier with PSMA scans, does it actually help patients live longer?


Here's what they did: they randomly split men with rising PSA levels after surgery into two groups. One group got a PSMA scan, and the other didn't. The ones without the PSMA scan just got the standard treatment of radiation therapy.


The results: Men who got PSMA scans had better outcomes. Why? Because the scan helped doctors:

• Find cancer in lymph nodes or other areas
• Expand the radiation field to treat all visible disease
• Make better decisions about adding hormone therapy

If your PSA is rising after surgery, ask your doctor about getting a PSMA PET scan. It's now covered by Medicare and most insurance companies in the United States for this situation.

Advanced Prostate Cancer: Understanding Your Options​

When prostate cancer spreads beyond the prostate (called metastatic disease), treatment gets more complex. But there are now several effective options available.

Hormone Therapy: The Foundation of Treatment​

Hormone therapy, also called androgen deprivation therapy (ADT), works by lowering testosterone levels in your body. Prostate cancer cells need testosterone to grow, so reducing it can slow or stop the cancer.


For many years, hormone therapy alone was the standard treatment for advanced prostate cancer. Now, we know that combining it with other drugs works better.

Newer Hormone Blockers​

There are several powerful drugs that block hormones more effectively than traditional hormone therapy alone:

• Enzalutamide (Xtandi)
• Apalutamide (Erleada)
• Darolutamide (Nubeqa)

These drugs are often called ARPIs (androgen receptor pathway inhibitors). They block testosterone's effects on cancer cells in multiple ways.


Research shows: When you combine standard hormone therapy with one of these newer drugs, men live significantly longer than with hormone therapy alone. We're talking about adding years to life expectancy.

Adding Chemotherapy​

For men with high-volume metastatic disease (meaning cancer has spread to multiple bones or organs), adding chemotherapy called docetaxel to hormone therapy can help even more.


The combination of hormone therapy plus a newer hormone blocker plus chemotherapy has been studied, and the results are positive. This "triplet therapy" approach helps aggressive cancers.

Protecting Your Bones​

When cancer spreads to bones or when you're on long-term hormone therapy, your bones can become weak. Drugs like denosumab or zoledronic acid help protect your bones and reduce the risk of fractures.


Recent research showed that men with bone metastases who took these bone-protecting drugs along with their cancer treatment lived significantly longer. The difference was dramatic: 71 months versus 23 months in one study.


Important: Talk to your doctor about bone health if you're on hormone therapy or have cancer in your bones. Bone protection should be part of your treatment plan.

PARP Inhibitors: Precision Medicine for Prostate Cancer​

PARP inhibitors are a type of targeted therapy that works especially well for men whose cancer has certain genetic mutations, particularly in genes called BRCA1 or BRCA2.

How PARP Inhibitors Work​

Think of PARP inhibitors as drugs that exploit a weakness in cancer cells. If your cancer has mutations in DNA repair genes (like BRCA), these drugs make it nearly impossible for cancer cells to fix damage to their DNA. Normal cells can still repair themselves, but cancer cells can't.

Who Benefits Most?​

You might be a candidate for PARP inhibitors if:

• Genetic testing shows your cancer has BRCA1, BRCA2, or other DNA repair mutations
• Your cancer has become resistant to hormone therapy
• You've already tried standard hormone treatments

Studies show that men with these genetic mutations who take PARP inhibitors live longer without their cancer getting worse. The drugs are most effective when your cancer has these specific mutations.


What you should know: If you have advanced prostate cancer, ask your doctor about genetic testing of your tumor. This test can reveal whether you might benefit from PARP inhibitors or other targeted therapies.

Radioligand Therapy: Delivering Radiation Directly to Cancer Cells​

One of the most exciting advances in prostate cancer treatment is radioligand therapy, also called RLT. The most well-known of these is Lutetium-177 PSMA.

How It Works​

Here's the basic idea: doctors attach a radioactive substance to a molecule that specifically targets prostate cancer cells. When you receive the treatment through an IV, it travels through your bloodstream and seeks out prostate cancer cells wherever they are in your body. Once it finds them, it delivers a dose of radiation directly to those cells.


It's like a smart bomb that finds and destroys cancer cells while mostly leaving healthy tissue alone.

Who Is It For?​

Lutetium-177 PSMA therapy (brand name Pluvicto) is currently approved for men with metastatic castration-resistant prostate cancer who have:

• Already tried hormone therapies and they stopped working
• Cancer cells that light up on a PSMA PET scan
• Cancer that has spread to multiple areas

The Future of Radioligand Therapy​

Researchers are now testing whether giving Lutetium-177 earlier in treatment, even for men whose cancer still responds to hormone therapy, might work even better. Several studies are underway looking at:

• Combining radioligand therapy with hormone blockers earlier in treatment
• Using it for men with oligometastatic disease (just a few spots of cancer)
• Developing new types of radioligands that might work even better

There are also newer radioligands being developed using different radioactive substances like Actinium-225, which might be even more powerful.

Oligometastatic Prostate Cancer: Treating Individual Spots​

Sometimes prostate cancer spreads to just a few spots in your body. This is called oligometastatic disease. Doctors used to think that once cancer spread, you could only slow it down with systemic therapy like hormone treatment.


Now we know that's not always true.

Stereotactic Body Radiation Therapy (SBRT)​

SBRT is a highly focused form of radiation that can target individual metastases with extreme precision. Recent studies have shown that treating these spots directly, in addition to hormone therapy, can help men live longer without their cancer progressing.


One Canadian study looked at men with oligometastatic castration-resistant prostate cancer. Half got enzalutamide alone, and half got enzalutamide plus SBRT to their metastases. The group that got both treatments went more than two years longer before their cancer progressed.


What this means for you: If your cancer has spread to just a few spots (typically five or fewer), ask your doctor whether treating those spots with focused radiation makes sense for you.

Dealing with Side Effects: Metformin and Metabolic Health​

One thing that doesn't get talked about enough is how hormone therapy affects your overall health. When you lower testosterone levels, it can lead to:

• Weight gain
• Higher blood sugar
• Increased risk of diabetes
• Higher cholesterol

Could Metformin Help?​

Metformin is a common diabetes drug that might help men on hormone therapy in multiple ways. Research suggests it might:

• Help prevent metabolic syndrome
• Potentially slow cancer growth
• Reduce some of the metabolic side effects of hormone therapy

While the cancer-fighting effects are still being studied, if you're on hormone therapy and starting to develop metabolic problems, metformin is worth discussing with your doctor.

What About Alternative Approaches?​

You might have heard about various supplements, diets, or alternative treatments for prostate cancer. While some lifestyle changes can certainly support your overall health, be cautious about anything claiming to cure or treat prostate cancer without medical evidence.


Proven lifestyle approaches that can help:

• Exercise: Regular physical activity helps combat the side effects of hormone therapy, maintains muscle mass, and improves quality of life
• Healthy diet: A diet rich in vegetables, fruits, and whole grains while limiting processed foods and red meat may help
• Weight management: Maintaining a healthy weight is important, especially on hormone therapy
• Stress management: Cancer treatment is stressful, and techniques like meditation or counseling can help

Always tell your oncologist about any supplements you're taking. Some can interfere with cancer treatments or cause unexpected side effects.

Understanding Your Risk: The Importance of Biomarkers​

Your PSA level is still one of the most important tools doctors have for tracking prostate cancer. Even with all the new technology, PSA remains the best biomarker for predicting how your cancer might behave.

What Your PSA Tells Your Doctor​

• How fast it's rising: A rapidly rising PSA often means more aggressive cancer
• How high it is: Higher levels generally indicate more advanced disease
• How well treatment is working: A falling PSA usually means treatment is effective

But PSA isn't the only biomarker. Genetic testing of your tumor can reveal:

• Whether you have mutations that respond to PARP inhibitors
• How aggressive your cancer is likely to be
• Which treatments are most likely to work

Treatment Guidelines Are Constantly Evolving​

One of the challenges for both doctors and patients is that prostate cancer treatment guidelines are constantly being updated based on new research. What was standard treatment five years ago might not be the best approach today.

First-Line Treatment Is More Complex Now​

In the past, if you had advanced prostate cancer, the treatment path was pretty straightforward. Now, your doctor needs to consider:

• What stage is your cancer?
• Has it spread, and if so, how much?
• What treatments have you already tried?
• Does your tumor have any genetic mutations?
• What's your overall health like?
• What are your priorities regarding side effects versus effectiveness?

There are now at least five different starting points depending on your situation, and each leads to different treatment paths.

Questions to Ask Your Doctor​

When discussing treatment options, here are some important questions to ask:

1. What stage is my cancer, and how aggressive is it?
2. Do I need genetic testing of my tumor?
3. What are my treatment options, and what are the pros and cons of each?
4. If I need radiation therapy, should I get a PSMA PET scan first?
5. Do I need hormone therapy, and if so, for how long?
6. Should I be on medication to protect my bones?
7. Are there clinical trials I should consider?
8. What side effects should I expect, and how can we manage them?
9. How will we monitor whether treatment is working?
10. What lifestyle changes would help?

The Importance of Early Detection and Monitoring​

One theme that runs through all the recent research is this: catching things early makes a huge difference in outcomes. Whether it's:

• Catching cancer early through screening
• Monitoring PSA closely after treatment
• Acting quickly if PSA starts rising
• Using advanced imaging when appropriate

The earlier problems are detected and addressed, the better your chances of successful treatment with fewer side effects.

Who Should Get Screened?​

Current guidelines suggest most men should discuss PSA screening with their doctor starting at age 50. If you're at higher risk (African American or family history of prostate cancer), start the conversation at age 40-45.


The decision to screen should be individualized based on your risk factors, overall health, and personal preferences.

Clinical Trials: Should You Consider Them?​

Many of the treatments discussed in this article started as clinical trials. Clinical trials give patients access to cutting-edge treatments before they're widely available.


Benefits of clinical trials:

• Access to new treatments that might work better than standard options
• Close monitoring by medical teams
• Contributing to research that helps future patients
• Often provided at no cost to you

Things to consider:

• Not all trials will be a good fit for your situation
• Some trials use placebos (though usually in addition to standard treatment, not instead of it)
• May require more frequent visits and tests

Ask your oncologist whether any clinical trials might be appropriate for your situation. Major cancer centers often have access to the newest trials.

Living Well with Prostate Cancer​

A prostate cancer diagnosis can feel overwhelming, but remember: many men live for years, even decades, with prostate cancer. The treatments available today are more effective and have fewer side effects than ever before.


Focus on what you can control:

• Stay informed: Understand your disease and treatment options, but don't let it consume your life
• Build your healthcare team: Find doctors you trust and who communicate well
• Lean on support: Family, friends, and support groups can make a huge difference
• Take care of your whole self: Physical health, mental health, and emotional wellbeing all matter
• Keep living: Don't put your life on hold. Make plans, enjoy hobbies, spend time with loved ones

Many men find that their cancer diagnosis motivates them to live more fully and focus on what really matters.

The Bottom Line: Hope for the Future​

Prostate cancer research is moving faster than ever. From smarter screening with MRI to targeted therapies like PARP inhibitors and radioligand therapy, men diagnosed today have more options than ever before.


The key is working closely with your medical team to create a personalized treatment plan based on:

• Your specific type and stage of cancer
• Your genetic markers
• Your overall health
• Your goals and preferences

Remember, not all prostate cancer needs immediate aggressive treatment. Some men can safely monitor low-risk disease. Others need combination therapies to fight aggressive cancer. There's no one-size-fits-all approach.

Take Action: What to Do Next​

If you've been diagnosed with prostate cancer or are concerned about your prostate health:

1. Schedule a thorough consultation with a urologist or medical oncologist who specializes in prostate cancer
2. Get genetic testing if you have advanced disease to see if you're a candidate for targeted therapies
3. Ask about PSMA PET imaging if your PSA is rising after treatment
4. Consider a second opinion at a major cancer center, especially for complex cases
5. Join a support group to connect with other men facing similar challenges
6. Stay up-to-date on the latest research and treatment options

The field of prostate cancer treatment is advancing rapidly. Treatments that weren't available even two or three years ago are now standard care. Working with knowledgeable doctors who stay current on the latest research gives you the best chance at successful treatment.


You're not alone in this fight. Thousands of researchers, doctors, and advocates are working every day to improve outcomes for men with prostate cancer. With early detection, appropriate treatment, and comprehensive care, many men with prostate cancer go on to live long, full lives.


Ready to take control of your prostate health? Talk to your doctor today about which screening and treatment options are right for you. Your future self will thank you for taking action now.

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This article is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider about your specific situation and treatment options.

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