Prostate cancer: advances in testing, scans and treatment

Prostate cancer is evolving rapidly: increasingly accurate tests, less intrusive scans and more intelligent medicines are transforming the way clinicians manage this widespread condition.

Throughout Europe and North America, researchers are reassessing every stage of care, from screening through to gene-targeted treatments. The objective is no longer to treat all patients alike, but to treat the appropriate cancer at the appropriate point, with the appropriate level of intervention.

A common cancer that may remain silent for years

In many Western nations, prostate cancer is the cancer most commonly diagnosed in men. It usually develops after the age of 50 and may not produce symptoms for many years. Certain tumours grow so slowly that they cause little harm, whereas others are aggressive, spreading to the bones or lymph nodes and becoming life-threatening.

The condition begins in the prostate, a small gland situated beneath the bladder which contributes to semen production. Its principal form is adenocarcinoma. Where symptoms develop early, they are commonly non-specific: a weaker urinary flow, waking during the night to pass urine, pelvic discomfort, or, at a later stage, bone pain and tiredness.

For many years, clinicians have depended on two main tests: the PSA (prostate-specific antigen) blood test and a digital rectal examination. Each has important shortcomings. PSA may be elevated for non-cancer reasons, including inflammation, while some men with aggressive tumours have PSA concentrations that are only slightly raised.

Prostate cancer is common, but its behaviour is extremely variable – from harmless to highly aggressive – which complicates screening and treatment choices.

This variation means “one-size-fits-all” screening policies can create harm. Finding a very small, slow-growing tumour in an 80-year-old and then treating it intensively may result in more harm than benefit.

From mass screening to targeted early detection

Health bodies in nations including France and the UK continue to take a careful approach to population-wide PSA screening programmes. Major trials have not demonstrated a substantial reduction in deaths, while many men have undergone avoidable biopsies and treatments.

In 2025, the direction of travel is towards risk-adapted, targeted screening. Decisions now give significant weight to age, predicted life expectancy, family history and genetic factors.

• Men aged 50–74 whose life expectancy exceeds 10 years are frequently considered for targeted screening.
• Screening can begin earlier, at approximately 45, for men with a strong family history or recognised genetic mutations, such as BRCA1 or BRCA2.
• PSA testing is less likely to offer benefit to men without symptoms who have a limited life expectancy.

The process after a raised PSA result or an abnormal-feeling prostate examination is also changing. Multiparametric MRI of the prostate has become an important gatekeeping test.

High-resolution MRI scans can spot suspicious areas and help avoid random, blind biopsies that carry infection and bleeding risks.

Radiologists are now able to score suspicious lesions and direct biopsies at them, instead of taking random tissue samples. This lowers overdiagnosis of small, harmless tumours and reduces the number of invasive procedures.

Blood testing has also advanced. Assays including the Prostate Health Index (PHI) and 4Kscore bring together several markers and clinical information to provide a better estimate of clinically significant cancer risk. Meanwhile, so-called “liquid biopsies” – blood tests that look for tumour DNA – are progressing from laboratory research towards clinical practice.

What new data say about organised screening

A major study released in 2025 found a 13% fall in prostate cancer-specific mortality across 23 years of structured, organised screening. Although the effect is modest, it has renewed discussion of carefully controlled programmes combining MRI with more selective testing, rather than universal PSA testing.

Rather than asking, “Should every man get a PSA test each year?”, clinicians are increasingly asking, “Who stands to gain from screening now, and who is more likely to be harmed?”

A quiet revolution in prostate cancer treatment strategies

Surgery, radiotherapy and hormone therapy continue to form the foundation of prostate cancer management. What differs in 2025 is the timing and manner in which these treatments are applied.

For localised, low-risk disease, “active surveillance” is becoming far more widely used. Men have regular PSA tests, MRI scans and occasional biopsies, with treatment held back unless the cancer starts to progress. The purpose is to prevent avoidable adverse effects, including erectile dysfunction and urinary incontinence.

For many slow-growing prostate cancers, the safest option is not immediate treatment, but close, structured monitoring.

In higher-risk or recurrent disease, radiotherapy is often given alongside hormone therapy that reduces or blocks testosterone. More potent anti-androgen medicines, including enzalutamide, are altering treatment at certain stages. Trial findings indicate that adding enzalutamide improves outcomes for men whose PSA rises after initial treatment but who do not yet have visible metastases. Regulators such as the US Food and Drug Administration have supported this use in particular settings.

Conversely, there is not yet clear evidence of benefit from adding enzalutamide to radiotherapy and standard hormone therapy for every high-risk patient. Clinicians remain cautious because intensified treatment may cause increased tiredness, hot flushes, metabolic complications and long-term sexual side-effects.

Imaging takes centre stage: whole-body SPECT

One of the more notable developments is emerging from nuclear medicine. Recent research has underlined the potential of whole-body SPECT, a three-dimensional scan capable of tracking minute changes in bone metastases with high sensitivity.

Conventional bone scans may fail to identify extremely small metastatic deposits. Whole-body SPECT can reveal micro-metastases and monitor how they change from day to day, producing a dynamic map of disease activity.

High-sensitivity 3D imaging allows oncologists to spot tiny metastatic lesions earlier and adjust treatment before symptoms worsen.

This technology could make it easier to personalise radiotherapy fields, inform systemic treatment choices and assess a medicine's effectiveness much sooner than was previously possible.

New research avenues: hormones, genes and beyond

Alongside established therapies, laboratories are investigating the delicate mechanisms that help prostate cancer cells survive, evade treatment and spread.

Re-wiring hormone sensitivity

Prostate cancer cells are strongly dependent on androgen receptors, which recognise testosterone and other male hormones. Conventional hormone treatments aim to deprive the cancer of this signalling or block it, but many tumours ultimately adapt.

Scientists are now examining other receptors that could function as restraints on tumour growth. The thyroid receptor TRβ is one potential candidate. Initial laboratory evidence indicates that activating TRβ might slow proliferation, restore responsiveness to anti-androgen medicines such as enzalutamide, and potentially strengthen radiotherapy's effect.

These results remain preclinical, but they suggest future combinations could influence hormone pathways more precisely instead of simply switching them off altogether.

CRISPR and the search for weak spots

Gene-editing technologies, including CRISPR-Cas9, are enabling researchers to chart the vulnerabilities of prostate cancer cells. Through large-scale CRISPR screening, teams have found proteins that sustain androgen receptor activity. PTGES3 is one such protein: it acts as a type of “chaperone”, helping the receptor to operate correctly.

Blocking critical helper proteins inside cancer cells could make them far more sensitive to existing hormone and radiation treatments.

In laboratory models, disabling PTGES3 appears to enhance hormone therapy and may raise radiosensitivity. Such methods are a long way from routine clinical use and present complex safety issues, but they illustrate the possible future direction of precision oncology.

Targeting DNA repair and using PARP inhibitors

Another major area of investigation concerns how prostate cancer cells repair DNA damage. Tumours with mutations in BRCA1, BRCA2 or other genes involved in homologous recombination repair often become highly reliant on alternative repair mechanisms.

PARP inhibitors, including olaparib, talazoparib and niraparib, inhibit one of these alternative pathways. This can drive cancer cells that already have repair faults beyond the point they can survive, resulting in cell death. These medicines are already licensed for breast and ovarian cancer, and selected cases of metastatic prostate cancer are now treated with them, particularly when modern hormone treatments have stopped working.

Treatment type	Main target	Typical use in prostate cancer
Hormone therapy	Testosterone and androgen receptor	Advanced or high-risk disease
PARP inhibitors	DNA repair enzymes	Metastatic disease with DNA repair defects
Radiotherapy	Tumour DNA and dividing cells	Localised and advanced stages

Some studies indicate that PARP inhibitors may help even where no definite BRCA mutation has been identified, although responses appear greater in genetically defined groups. Access to genomic testing and multidisciplinary teams is becoming a practical necessity for these decisions, and not every hospital is yet fully equipped.

Building genuine precision medicine

Oncologists are increasingly referring to “prostate cancers” rather than one single disease. Viewed through the microscope and genetic sequencing, tumours reveal markedly different genetic profiles, growth rates and weaknesses.

Modern care pathways are beginning to bring together three core elements:

• Genomics: sequencing tumour DNA to find actionable mutations and repair defects.
• Imaging: sophisticated MRI, PET scans and whole-body SPECT to monitor spread and activity.
• Data science: algorithms using extensive datasets to forecast which tumours are most likely to act aggressively.

Precision medicine aims to match each man with the treatment most likely to help him, not just the standard protocol for his stage.

In practical terms, this could mean surveillance alone for a man with a small, low-grade tumour and no high-risk genes, while another man with a similar PSA result but a BRCA2 mutation and a suspicious MRI may move directly to combined radiotherapy and systemic treatment.

What men should know before talking to their doctor

For men making decisions about prostate cancer, the emerging science may seem daunting. Several practical points can help guide the discussion:

• Ask not only “Do I have cancer?” but “How aggressive is this cancer likely to be?”
• Consider life expectancy and other health conditions when deciding on screening or treatment.
• Ask whether active surveillance is available and how closely it would be monitored.
• With advanced disease, ask whether genetic testing could affect treatment decisions.

Considering two 65-year-old men helps demonstrate the difference. One is active, has few health concerns and an expected lifespan of 20 years. The other has serious heart disease and restricted mobility. The same low-grade tumour could lead to treatment for the first man, but straightforward monitoring or even no intervention for the second, because the balance between benefits and risks is very different.

It is also important to understand terms such as “biochemical recurrence” (a rising PSA after treatment) and “non-metastatic” (no visible spread on scans). Many of the latest medicines, including advanced hormone agents, are aimed at these particular situations. A rising PSA on its own does not necessarily signal immediate danger, but it does prompt a more detailed, personalised assessment.