Top Line: With more therapeutic options at our fingertips than ever, prostate cancer management is less about what we can do and more about who needs it and when.
The Study:This narrative review walks through the modern prostate cancer landscape, from PSA-based detection and risk stratification to the expanding menu of treatments across disease states. Localized disease remains dominated by active surveillance for low-risk tumors, reflecting hard-earned lessons about overdiagnosis and overtreatment, while surgery and radiation–including dose-escalated external beam, hypofractionation, brachytherapy, and combinations thereof–anchor curative-intent therapy for higher-risk patients. In advanced disease, systemic therapy has exploded: ADT remains the backbone but next-generation androgen receptor pathway inhibitors, chemotherapy, radiopharmaceuticals, and PARP inhibitors (for defects in homologous recombination repair) are increasingly sequenced earlier and often in combination. Imaging advances, namely PSMA PET, are reshaping staging and recurrence detection, though how best to act on these findings remains an open question. The challenge in 2026 won’t be a lack of tools, it will be understanding when to and not to use them.
TBL: Prostate cancer care is now a masterclass in risk-adapted decision-making—doing less for indolent disease, more and sooner for aggressive biology, and constantly balancing oncologic control with quality of life. | Fonteyne, Lancet 2025
The Study:This narrative review walks through the modern prostate cancer landscape, from PSA-based detection and risk stratification to the expanding menu of treatments across disease states. Localized disease remains dominated by active surveillance for low-risk tumors, reflecting hard-earned lessons about overdiagnosis and overtreatment, while surgery and radiation–including dose-escalated external beam, hypofractionation, brachytherapy, and combinations thereof–anchor curative-intent therapy for higher-risk patients. In advanced disease, systemic therapy has exploded: ADT remains the backbone but next-generation androgen receptor pathway inhibitors, chemotherapy, radiopharmaceuticals, and PARP inhibitors (for defects in homologous recombination repair) are increasingly sequenced earlier and often in combination. Imaging advances, namely PSMA PET, are reshaping staging and recurrence detection, though how best to act on these findings remains an open question. The challenge in 2026 won’t be a lack of tools, it will be understanding when to and not to use them.
TBL: Prostate cancer care is now a masterclass in risk-adapted decision-making—doing less for indolent disease, more and sooner for aggressive biology, and constantly balancing oncologic control with quality of life. | Fonteyne, Lancet 2025