Loading
Every dated change on the records linked to Prostate cancer, newest first: approvals and regulatory steps on its medicines, trials that reported, guideline versions, milestones, and when this page itself was checked. Dates come from the records; none is inferred. Orientation, not medical advice.
Capivasertib approved for use with abiraterone and prednisone in PTEN-deficient metastatic prostate cancer (CAPItello-281); abiraterone itself was already approved
PTEN-deficient metastatic prostate cancer with abiraterone (CAPItello-281)
FDA approves capivasertib with abiraterone and prednisone for PTEN-deficient androgen pathway modulation-naïve or -sensitive prostate cancer
PTEN-deficient metastatic prostate cancer with abiraterone
Pylarify TruVu formulation
Median overall survival 38.
A milestone in how this cancer is treated.
Localised prostate cancer risk stratification and ADT benefit prediction
Gozellix kit; selection of patients for PSMA-targeted radioligand therapy
Median rPFS 33.
rPFS significantly improved.
Median overall survival 24.
Median radiographic progression-free survival 8.
Radiographic progression-free survival hazard ratio 1.
rPFS HR 0.
A milestone in how this cancer is treated.
Darolutamide plus androgen deprivation lengthened radiographic progression-free survival compared with androgen deprivation alone; approved for this use in 2025.
5-year biochemical or clinical failure-free 95.
No difference between protons and IMRT in EPIC bowel quality of life at 24 months (primary endpoint, p=0.
Ten-year metastasis-free survival 78.
rPFS HR 0.
A milestone in how this cancer is treated.
PSMA PET in prostate cancer
EU brand Pylclari (Curium)
Prostate cancer goes to bone more reliably than almost any other cancer, and the emergency that follows is the one men are least often warned about. Metastatic spinal cord compression happens when deposits in or near the spine press on the spinal cord, and Prostate Cancer UK says about 4 in 100 people with prostate cancer develop it, with the risk highest once the cancer has reached the spine. Untreated it causes nerve damage and can cause paralysis; treated quickly, the risk of that being permanent falls. The signs are worth learning by heart: new, severe or progressive back or neck pain, pain worse on coughing, straining, lying down or at night, tenderness over the spine, a band of pain around the chest or abdomen, pain running down an arm or leg, weakness or unsteadiness in the legs, numbness or pins and needles that does not go away, and any loss of control of the bladder or bowel. NICE NG234 (1.3.2) says to immediately contact the metastatic spinal cord compression coordinator for anyone with a past or current cancer diagnosis and those signs, and to treat it as an oncological emergency; (1.3.3) asks for advice within 24 hours for the pain pattern alone; (1.5.2) asks for an MRI as soon as possible and always within 24 hours; and (1.4.1 to 1.4.3) ask for immobilisation and nursing flat while that is arranged. Prostate Cancer UK adds the practical instruction: do not wait to see if it settles, do not worry that it is the evening or the weekend, ask the team in advance to write down who to contact during the day, at night and at weekends, and if you cannot reach anyone, go to A and E and tell them you have prostate cancer and symptoms of spinal cord compression, because not everyone who sees you will be familiar with it. Alongside the emergency sits the ordinary work of protecting a skeleton. NICE NG131 (1.5.19) says to consider zoledronic acid to prevent or reduce skeletal-related events in hormone-relapsed metastatic disease and (1.5.20) bisphosphonates for pain where painkillers and palliative radiotherapy have not been enough; (1.3.35) says not to offer bisphosphonates to prevent bone metastases developing, and (1.4.12) not to offer them routinely to prevent osteoporosis on hormone therapy. Those are three different questions and NICE gives them three different answers, which is why a single yes or no about bone drugs usually means the wrong question was asked. Radium-223 remains an option for symptomatic bone-only disease that is no longer responding to hormone therapy, with bone protection alongside. A word about words: NICE calls that state hormone-relapsed prostate cancer, many hospitals and papers call it castration-resistant or castrate-resistant, and the three mean the same thing, which is prostate cancer that has started growing again despite testosterone being switched off.
MFS HR 0.
rPFS HR 0.
rPFS HR 0.
Median imaging-based progression-free survival 11.
A milestone in how this cancer is treated.
TRITON3 randomised 405 men and found imaging-based progression-free survival of 11.2 against 6.4 months in the BRCA subgroup, and a hazard ratio of 0.95 in the ATM subgroup: no effect. 4,855 men were screened to randomise 405.
PSMA PET in prostate cancer
PSMA PET in prostate cancer, including selection of patients for PSMA radioligand therapy
High-volume metastatic hormone-sensitive prostate cancer with androgen deprivation therapy
OS HR 0.
Clinically insignificant cancer 0.
Overall survival not improved: stratified hazard ratio 1.
BRCA cohort rPFS HR 0.
rPFS HR 0.
Five-year freedom from progression after prostatectomy 70.
Cell-free DNA methylation separates neuroendocrine from castration-resistant adenocarcinoma with near-perfect discrimination in two small cohorts; a 2,069-man single-centre series shows tumour genomes differ by self-reported race after adjusting for clinical factors, with more 8q gain in tumours from Black men and an association between community income and 8q gain.
A milestone in how this cancer is treated.
PSMA PET imaging in prostate cancer
PSMA PET imaging in prostate cancer (initial staging with suspected metastasis; suspected recurrence)
Aid to pathologists in detecting areas suspicious for cancer on prostate needle biopsy slides (De Novo)
PSMA PET imaging in prostate cancer
Transdermal oestradiol suppressed testosterone as well as a luteinising hormone-releasing hormone agonist with no difference in time to first cardiovascular event (hazard ratio 1.
OS HR 0.
5-year biochemical failure-free survival 95% (whole pelvis) vs 81.
Per-patient sensitivity 0.
PSA50 66% vs 37%; OS HR 0.
OS HR 0.
KEYNOTE-199 gave objective response rates of 5 and 3 percent with pembrolizumab and PD-L1 predicted nothing, consistent with a median tumour mutational burden of 2.6 mutations per megabase. TRANSFORMER found identical progression-free survival for high-dose testosterone and enzalutamide and a difference of 8.6 months in progression-free survival through crossover depending on which came first.
Circulating tumour DNA is detectable in 94% of 3,334 men with advanced prostate cancer and agrees with tissue on BRCA mutations 93% of the time; in parallel, clonal haematopoiesis is shown to account for almost half the somatic repair-gene variants found in plasma, most often in ATM.
A milestone in how this cancer is treated.
Olaparib in germline BRCA-mutated metastatic castration-resistant prostate cancer
PSMA PET (UCLA/UCSF NDA); kits 2021-2022
Advanced prostate cancer
Event-free survival hazard ratio 0.
Five-year event-free survival 92 percent with adjuvant against 90 percent with salvage radiotherapy (hazard ratio 0.
Sustained castration through 48 weeks in 96.
Progression at 6 months 19 percent after stereotactic ablative radiotherapy against 61 percent under observation (p=0.
rPFS HR 0.
Accuracy 92% vs 65%.
Five-year biochemical progression-free survival 85 percent with adjuvant against 88 percent with early salvage radiotherapy (hazard ratio 1.
Five-year freedom from biochemical progression 87 percent with early salvage against 86 percent with adjuvant radiotherapy (hazard ratio 1.
A milestone in how this cancer is treated.
In 302 randomised men, PSMA PET-CT is 27% more accurate than CT with bone scan, changes management twice as often and delivers less than half the radiation.
CE mark
Prostate cancer has an unusually full trial landscape, because the number of things worth testing keeps growing: radioligands moving earlier in the disease, PARP inhibitor and AR-pathway combinations selected by genetics, T-cell engagers against STEAP1 and KLK2, and, at the other end, trials of how to monitor low-risk disease with fewer biopsies. NICE NG131 names trials at several points rather than as a last resort: (1.3.28) says high-intensity focused ultrasound and cryotherapy should be used for localised disease only in controlled trials comparing them with established treatments, which is the answer to give when a focal treatment is offered privately; (1.3.32 and 1.3.33) say the same about immediate post-operative radiotherapy and adjuvant hormone therapy after prostatectomy; (1.3.58) says to consider trial entry for biochemical relapse; and (1.2.5) restricts mapping transperineal template biopsy at initial assessment to trials. The practical questions are the ordinary ones. The NHS says you can ask your doctor or a patient organisation about trials you may be eligible to join, that you would usually be randomly assigned to the new treatment or to a control group, and that you can leave at any point without giving a reason and without it affecting your care. Worth asking as well: whether taking part means travelling, how many extra scans and biopsies it involves, whether the trial covers travel costs, and what happens to your treatment when the trial ends.
After radical treatment the PSA becomes the thing everyone watches, and the waiting for each result has its own name in the clinic. NICE NG131 (1.3.47) says to check it no earlier than 6 weeks after treatment, then at least every 6 months for the first 2 years and at least once a year after that, and (1.3.48) not to do a routine rectal examination while it stays at baseline; (1.3.49) allows remote follow-up after the first 6 months for people with a stable PSA and no significant complications, which for many men means a blood test locally and a phone call. The most useful sentence in the guideline for anyone watching a number go up is (1.3.55): a rising PSA alone should not mean an immediate change in treatment. What matters is the speed, so (1.3.56) asks for the doubling time to be estimated from at least three measurements over at least six months. After a prostatectomy with no known metastases the standard answer is radiotherapy to the prostate bed (1.3.57), often still given with the aim of cure. NG131 (1.3.54) says not to offer routine MRI before salvage radiotherapy but to offer an isotope bone scan if symptoms or PSA trends suggest metastases, and (1.3.58) to consider entry to a clinical trial; in practice a PSMA PET scan is now what localises the disease, and the imaging rows on this page say what it can and cannot see. Hormone therapy is deliberately held back: (1.3.59) says not to offer it routinely for biochemical relapse unless there is symptomatic local progression, proven metastases, or a doubling time of less than three months, which is the guideline protecting men from years of side effects for a number rather than a disease. Where the risk is high, the EMBARK trial is the evidence for adding enzalutamide at this point, and that is a conversation for the multidisciplinary team rather than a default.
These are the two things men do not raise, so this page raises them first. On continence: most men leak when the catheter comes out after a prostatectomy, usually seven to ten days after the operation, because the operation disturbs the sphincter and the pelvic floor. It improves. In ProtecT, pad use after surgery was 46 percent at six months and 17 percent at six years; radiotherapy barely touched continence at 4 to 5 percent. What helps, in the order the guideline puts it: pelvic floor muscle exercises, started four to six weeks before the operation and restarted as soon as the catheter is out; absorbent pads and pants, sheaths, bed protectors and clamps while things settle; bladder retraining for urgency; and, where it does not settle, medicines, an internal male sling for men leaking two to three pads a day at a year, or an artificial urinary sphincter for men still leaking heavily six months on. NICE NG131 (1.3.39) requires access to specialist continence services, (1.3.40) referral for consideration of an artificial urinary sphincter for intractable stress incontinence, and (1.3.41) rules out bulking agent injections. On sexual function: the figures are in the first row of this page, and they are worth reading with someone rather than alone. What is worth knowing is that the services exist and that starting early works better. NICE NG131 (1.3.36) says to offer access to specialist erectile dysfunction services after radical treatment, (1.3.37) to offer PDE5 inhibitor tablets, and (1.3.38) to offer vacuum devices, intraurethral inserts, penile injections or a penile prosthesis where tablets fail or are contraindicated; (1.4.8) extends the same access to men starting hormone therapy and (1.4.10, 1.4.11) repeats the ladder for them. All of it is free on the NHS whether the erection is wanted for sex or for masturbation, and there is no age limit. Prostate Cancer UK says to try each type of tablet at least eight times before moving on, that injections work within 5 to 10 minutes and often work even when desire is low, that about 3 in 100 implants get infected and roughly 5 in 100 inflatable implants need replacing within ten years, and that an erection lasting more than four hours is priapism and means going straight to accident and emergency. Two other things men are rarely told: the penis can become shorter or curved after surgery, and using a vacuum pump early, alone or with tablets, may help preserve it; and orgasm survives even when ejaculation does not, though it feels different, and some men leak urine at orgasm, which pelvic floor exercises help. Beside all of this NICE NG131 (1.1.13) offers the man and his partner the chance to talk to a healthcare professional experienced in psychosexual issues at any stage, and (1.4.9) considers psychosexual counselling for couples on long-term hormone therapy. Taking that offer is not an admission of anything.
Choosing radiotherapy is choosing a schedule and a course of hormone therapy at the same time, and men are often surprised by the second part. On the schedule, NICE NG131 (1.3.19) says to offer hypofractionated radiotherapy, 60 Gy in 20 fractions, using image-guided intensity modulated radiation therapy unless contraindicated, with conventional radiotherapy, 74 Gy in 37 fractions, reserved for people who cannot have the shorter course. Twenty visits over four weeks is therefore the standard rather than a lesser version of it. NG131 (1.3.24) says to consider adding a brachytherapy boost, where radioactive sources are placed in the prostate itself, for CPG 2 to 5, and (1.3.25) not to offer brachytherapy alone at CPG 4 and 5, so whether a boost is available is a question about the centre. On the hormone therapy, NG131 (1.3.21) says to offer radical radiotherapy combined with androgen deprivation therapy rather than either alone for CPG 2, 3, 4 and 5, (1.3.22) six months of it before, during or after the radiotherapy, and (1.3.23) to consider continuing for up to 3 years at CPG 4 and 5 while discussing the benefits and risks of that with the person. This matters because almost everything men describe afterwards as the effect of radiotherapy is the effect of the hormone therapy: the hot flushes, the loss of sex drive, the weight around the waist, the tiredness. The radiotherapy's own signature is in the bowel and the bladder in the weeks around treatment, and in the small late risks: NG131 (1.3.6) asks that people are told about the small increase in the risk of colorectal cancer after radical external beam radiotherapy, and (1.3.42) that anyone with signs of radiation-induced enteropathy is cared for by a team with expertise in it. For high-risk disease starting long-term hormone therapy, NG131 (1.3.26) asks for a separate discussion about adding six cycles of docetaxel, with box 3 setting out both sides plainly: clear evidence that progression is delayed by about a year, a five-year survival difference of 84 against 80 out of 100 that might be chance, and 15 out of 100 developing a fever from a low white count with 1 in 100 dying of an infection they might not otherwise have had.
Hormone therapy is the longest part of this illness for most men and the least well covered. It works by taking testosterone away, and testosterone was doing a great many other things. The effects last for as long as the treatment does, and Prostate Cancer UK says that after stopping it can take several months to several years for them to settle, while an orchidectomy cannot be reversed at all. Hot flushes are the commonest complaint: NICE NG131 (1.4.3) says to offer medroxyprogesterone 20 mg a day for an initial 10 weeks and to evaluate the effect at the end, and (1.4.4) to consider cyproterone acetate 50 mg twice a day for 4 weeks if that fails or is not tolerated; in a randomised trial of 309 men the median daily hot-flush score fell by 83.7 percent on medroxyprogesterone and 94.5 percent on cyproterone at one month, against 47.2 percent on venlafaxine. NG131 (1.4.5) also says plainly that there is no good-quality evidence for complementary therapies here. Bone thinning starts in the first year and increases with time on treatment: in 50,613 men, 19.4 percent of those on androgen deprivation surviving at least five years had a fracture against 12.6 percent of those not on it. NICE's four bone sentences run in a specific order: (1.4.12) do not routinely offer bisphosphonates to prevent osteoporosis, (1.4.13) consider assessing fracture risk, (1.4.14) offer bisphosphonates to those who have osteoporosis, and (1.4.15) consider denosumab where bisphosphonates are contraindicated or not tolerated. A DEXA scan is how the question is answered. On the heart and the metabolism, in 73,196 Medicare enrollees GnRH agonist use carried adjusted hazard ratios of 1.44 for new diabetes, 1.16 for coronary heart disease, 1.11 for myocardial infarction and 1.16 for sudden cardiac death; in the HERO trial, major adverse cardiovascular events occurred in 2.9 percent of 622 men on oral relugolix against 6.2 percent of 308 on leuprolide over 48 weeks. Prostate Cancer UK suggests general health checks roughly every six months: weight, blood pressure, cholesterol and a diabetes check. Body composition changes: muscle goes, fat arrives, particularly at the waist, and joint and muscle aches follow. NICE NG131 (1.4.18) says to tell people that fatigue is a recognised effect of the therapy and might not be the cancer, and (1.4.19) to offer supervised resistance and aerobic exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life, which is the single most concrete offer in this section. On mood, Prostate Cancer UK says hormone therapy itself can cause tearfulness, mood swings, low mood, anxiety and depression, and a meta-analysis of 18 studies in 168,756 men found a 41 percent higher risk of depression on androgen deprivation. Memory and concentration change too, though the evidence for a direct cause is weak. Gynaecomastia has its own answer: NG131 (1.4.16) says to offer prophylactic radiotherapy to both breast buds within the first month for people starting long-term bicalutamide monotherapy, a single 8 Gy fraction, with weekly tamoxifen considered if that does not work. And where treatment is long-term and not adjuvant, NG131 (1.4.1) says to consider intermittent therapy, discussing the limited evidence for a reduction in side effects and the effect on progression, with PSA measured every 3 months and treatment restarted at 10 nanogram/ml or above.
This is the decision the whole of prostate cancer turns on, and it is unusual because the three options are not ranked. NICE NG131 (1.3.8 to 1.3.12) writes one recommendation per Cambridge Prognostic Group: active surveillance is offered first at CPG 1, a choice between all three is offered at CPG 2, radical treatment is offered at CPG 3 with surveillance kept open for men who choose not to be treated immediately, and surveillance is not offered at CPG 4 and 5. If you were given a risk band instead of a number, the bridge is that CPG 1 is low risk, CPG 2 and 3 are intermediate risk and CPG 4 and 5 are high risk; the group is worked out from your Gleason score or grade group, your PSA and your T stage, and a UK pathology report carries the Gleason score and the grade group together. For CPG 1 to 3, NICE (1.3.7) sends the conversation to its box 2, which is a table of what happened to 100 men offered each option in the UK ProtecT trial, and the honest summary of that table is that survival was the same and the harms were not. On survival, box 2 reports that at 10 years, 98 out of 100 men offered monitoring, 99 out of 100 offered prostatectomy and 99 out of 100 offered radiotherapy had not died of prostate cancer, and that the evidence does not show a difference between them. At a median of 15 years the trial found death from prostate cancer in 17 of 545 men (3.1 percent) on monitoring, 12 of 553 (2.2 percent) after prostatectomy and 16 of 545 (2.9 percent) after radiotherapy, with the overall comparison not significant. What treatment changed was spread: metastases in 51 men (9.4 percent) on monitoring against 26 (4.7 percent) and 27 (5.0 percent), and clinical progression in 141 (25.9 percent) against 58 (10.5 percent) and 60 (11.0 percent). A quarter of the monitoring group, 133 men, were alive at the end of follow-up with no prostate cancer treatment of any kind. On continence, box 2 reports moderate to severe incontinence at 6 months in 19 out of 100 men offered prostatectomy against 4 on monitoring and 6 after radiotherapy, and at 6 years in 13, 8 and 5. The trial's own patient-reported figures are blunter: pad use went from 1 percent before treatment to 46 percent at 6 months after surgery, against 4 percent and 5 percent in the other two groups, and was still 17 percent at 6 years and 18 to 24 percent through years 7 to 12. On sexual function, box 2 reports moderate or severe erectile dysfunction at 6 months in 66 out of 100 men offered prostatectomy, 48 after radiotherapy and 29 on monitoring, and at 6 years in 50, 36 and 40. Of the men in the trial, 67 percent could get an erection firm enough for intercourse before anything was done; at 6 months that was 12 percent after surgery, 22 percent after radiotherapy and 52 percent on monitoring, and by year 12 all three groups had converged at a low level. On bowels, radiotherapy is the one that costs: moderate to severe impact of bowel habits on quality of life at 6 months in 10 out of 100 men offered radiotherapy against 3 in each other group, and faecal leakage in 12 percent of the radiotherapy group against 6 percent of the others by year 12. Nothing in this row is a prediction about one man. It is what happened to 1,643 UK men aged 50 to 69 with mostly CPG 1 to 3 disease, and the reason to read it is that it names the trade-off rather than gesturing at it. NICE surrounds the choice with process: a decision aid in the clinic (1.1.6), nomograms with their limits explained (1.1.7), all relevant options discussed even when the local service does not offer them (1.1.9), an assessment by both a specialist surgical oncologist and a specialist clinical oncologist (1.3.5), and an explicit conversation about sexual function, physical appearance, continence and other aspects of masculinity with the man and, if he wishes, his partner (1.1.12).
Palliative care in prostate cancer is often needed for years rather than weeks, because men live a long time with metastatic disease, and the guideline treats it that way. NICE NG131 (1.5.4) says to ensure palliative care is available when needed and is not limited to the end of life, and that care should not be restricted to being associated with hospice care. NG131 (1.5.1) asks for tailored information and access to specialist urology and palliative care teams from the point of a metastatic diagnosis, (1.5.2) for palliative interventions to be integrated at any stage into coordinated care with smooth transitions between settings, (1.5.3) for personal preferences and the preferred place of care to be discussed as early as possible with the man, his partner and his carers, and (1.5.5) for a regular assessment of needs rather than waiting to be asked. In practice this is the team that manages bone pain, fatigue, bowel and bladder symptoms, the fear that arrives with each PSA result, and the conversations nobody else starts. Marie Curie says palliative care can be given alongside treatments aimed at controlling the illness, which is the sentence to quote if a referral feels like a verdict. Alongside it sit the things that keep a life working: Maggie's centres, which are free and need no appointment; Prostate Cancer UK's specialist nurses, one-to-one peer support and online community; a carer's assessment, which is free and is for the person doing the caring rather than the patient; and help with money and work, which is easier to arrange early than late.
Radiographic progression-free survival at 24 months 68.
Darolutamide lengthened metastasis-free and overall survival compared with placebo with a near-placebo side-effect profile; approved in July 2019.
rPFS HR 0.
Closed early after 38 of a planned 148 men were randomised; AR-V7 prevalence 8 percent (95 percent confidence interval 6 to 10) among 953 prescreened men.
Median imaging-based progression-free survival 8.
Enzalutamide added to testosterone suppression improved overall survival compared with a standard non-steroidal antiandrogen.
Median symptomatic skeletal event-free survival 22.
Rate ratio for prostate cancer death 0.
Progression-free survival at 120 months 64 percent with salvage radiotherapy plus 6 months of goserelin against 49 percent with radiotherapy alone (hazard ratio 0.
Median overall survival 45 vs 43 months (hazard ratio 0.
5-year failure-free survival 84% in both arms, non-inferior.
Four-year overall survival 93 against 89 percent with adjuvant docetaxel added to androgen suppression and radiotherapy (hazard ratio 0.
Median overall survival 34.
5-year OS 42.
Microsatellite instability-high or mismatch repair deficient disease is found in 3.1% of 1,033 men, with durable checkpoint inhibitor responses in 6 of 11 treated; gallium-68 PSMA-11 PET is shown prospectively to localise recurrence in 75% of 635 men with a rising PSA. RB1 alteration emerges as the only genomic marker independently predicting shorter survival in castration-resistant disease.
Median metastasis-free survival 40.
Clinically significant cancer 38% vs 26%.
Enzalutamide lengthened metastasis-free survival and, with longer follow-up, overall survival compared with placebo; approved in July 2018.
Prostate cancer deaths 71 of 347 with surgery against 110 of 348 with watchful waiting (relative risk 0.
Median androgen deprivation-free survival 21 months with metastasis-directed therapy against 13 months with surveillance (hazard ratio 0.
A milestone in how this cancer is treated.
Deep whole genomes of 101 metastases find the AR upstream enhancer amplified in 81% of men, invisible to exome panels; reanalysis of 1,013 exomes finds 97 driver genes, 70 of them new, most below 3%.
SPCG-4 at 29 years: surgery cut prostate cancer death by 45 percent in clinically detected disease and added a mean 2.9 years of life. PIVOT at 19.5 years, in a largely screen-detected population, found no significant difference. Dess showed that once treatment and access are equal, the excess prostate cancer mortality in Black men largely disappears while the excess other-cause mortality does not.
Unilateral, low-risk, previously untreated prostate adenocarcinoma in men with life expectancy of at least 10 years (Tookad VTP)
Median overall survival 14.
Nine-year biochemical progression-free survival 83 percent with a low-dose-rate brachytherapy boost against 62 percent with a dose-escalated external beam boost (multivariable hazard ratio for failure 2.
Disease progression at 24 months in 28 percent after padeliporfin vascular-targeted photodynamic therapy against 58 percent under active surveillance (adjusted hazard ratio 0.
Median overall survival 24.
OS HR 0.
All-cause mortality 61.
Five-year biochemical and clinical failure-free survival 85 percent in both arms (hazard ratio 0.
Multiparametric MRI sensitivity 93 percent against 48 percent for transrectal biopsy, at the cost of specificity (41 against 96 percent); as a triage test it would spare 27 percent of men a biopsy and find up to 18 percent more clinically significant cancers.
Median overall survival 13.
12-year overall survival 76.
Median overall survival 23.
A milestone in how this cancer is treated.
Above a 2% tumour fraction, plasma reproduces every somatic mutation found in a matched metastatic biopsy, which is the number that makes a liquid biopsy reportable in this disease; in the same year BRCA2 reversion is identified as the mechanism of PARP inhibitor resistance.
Mu and Ku showed that losing TP53 and RB1 lets a prostate cancer cell switch on SOX2 and stop needing the androgen receptor, reversibly in the laboratory. PROMIS showed multiparametric magnetic resonance imaging is 93 percent sensitive for clinically significant cancer against 48 percent for standard biopsy, and could spare a quarter of men a biopsy.
PET imaging in men with suspected prostate cancer recurrence based on elevated PSA
Median radiographic progression-free survival 7.
5-year biochemical or clinical failure-free survival 90.
Median overall survival 11.
Six months of androgen suppression added to radiotherapy improved biochemical disease-free survival (hazard ratio 0.
15-year prostate-cancer mortality 3.
Five-year disease-free survival 86.
Abiraterone + ADT: OS HR 0.
Pritchard found presumed deleterious germline DNA repair mutations in 11.8 percent of 692 men with metastatic prostate cancer, BRCA2 in 5.3 percent, with no relation to family history or age at diagnosis. The argument for testing every man with metastatic disease rather than selecting by family history.
A milestone in how this cancer is treated.
Methylation separates neuroendocrine from castration-resistant adenocarcinoma far more sharply than mutations do, in a pattern fitting divergent clonal evolution from a common ancestor rather than a late mutational event.
OS HR 0.
Five-year overall survival 95 against 86 percent (hazard ratio 2.
Median radiographic progression-free survival 13.
Adding radiotherapy to lifelong androgen deprivation in locally advanced prostate cancer improved overall survival (hazard ratio 0.
A milestone in how this cancer is treated.
TCGA put 74 percent of 333 primary tumours into seven subtypes and found DNA repair inactivation in 19 percent; the Stand Up To Cancer cohort sequenced 150 metastatic biopsies and found BRCA2, BRCA1 and ATM aberrations in 19.3 percent; TOPARP-A treated 50 unselected men with olaparib and 14 of the 16 with DNA repair defects responded. Gundem showed metastases seed other metastases.
Median overall survival 11.
Radiographic progression-free survival at 12 months 65 against 14 percent (hazard ratio 0.
Antonarakis found AR-V7, an androgen receptor lacking the part the drugs bind, in circulating tumour cells: a zero percent prostate-specific antigen response rate to enzalutamide and abiraterone in the men who carried it, against 53 and 68 percent in those who did not.
The Prostate Cancer Foundation working committee publishes the six categories that separate incidental neuroendocrine staining from small cell carcinoma, which is what makes treatment-emergent neuroendocrine disease countable at all.
OS HR 0.
Median radiographic progression-free survival 16.
Median overall survival 58.
Median overall survival 21.
Median survival 5.
Median overall survival 17.
Among 2,019 men, carriers present at higher grade and stage and live 8.6 years from diagnosis against 15.7 for non-carriers, which is why a carrier's localised disease is treated rather than watched.
A milestone in how this cancer is treated.
PET imaging of suspected prostate cancer recurrence with non-informative conventional imaging
Median overall survival 18.
Median overall survival 22.
Median overall survival 24.
Biochemical progression-free survival hazard ratio 0.
The United States task force issued a grade D recommendation against prostate-specific antigen screening at any age; it moved men aged 55 to 69 to grade C in 2018. In the same year AFFIRM reported enzalutamide after chemotherapy, 18.4 against 13.6 months, with a prostate-specific antigen response rate of 54 percent against 2 percent.
Exome sequencing of 112 tumours makes SPOP the commonest point mutation in prostate cancer and shows SPOP-mutant tumours never carry an ETS fusion; rapid-autopsy sequencing of 50 lethal cancers adds CHD1 deletion, FOXA1 mutation and the chromatin genes that partner the androgen receptor.
Median overall survival 14.
Ten-year overall survival 62 against 57 percent (hazard ratio for death with radiotherapy alone 1.
Proof that castration-resistant disease is still AR-driven.
AURKA and MYCN are co-amplified in 40% of neuroendocrine prostate cancers against 5% of adenocarcinomas, and Aurora kinase inhibition switches off the neuroendocrine programme in models.
Asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer
Ten-year overall survival 58.
Median overall survival 25.
Median survival 15.
TROPIC gave cabazitaxel after docetaxel: 15.1 against 12.7 months, with grade 3 or higher neutropenia in 82 percent. Prostate cancer became a sequencing problem rather than a single-treatment disease.
Profiling 218 tumours on three platforms identifies NCOA2 as an oncogene in 11% and shows that counting copy-number changes separates high- from low-risk disease beyond Gleason score.
Same
Five-year overall mortality 19.
Prostate cancer death rate 2.
Ten-year prostate cancer mortality 11.
Metastasis-free survival hazard ratio 0.
ERSPC found a 20 percent reduction in prostate cancer mortality, at 1,410 men screened and 48 extra cancers treated per death prevented. PLCO found no difference, with control-group screening at 52 percent by year six. Welch and Albertsen counted 1,305,600 extra United States diagnoses and 1,004,800 definitive treatments since 1986.
Advanced prostate cancer
At 10 years, 24 extra months of goserelin improved disease-free survival (22.
Attard's phase 1 of abiraterone in 21 men resistant to multiple hormonal therapies produced prostate-specific antigen falls of at least 50 percent in 12 of them, lasting up to at least 578 days. The disease was renamed from hormone-refractory to castration-resistant on the strength of results like this.
Median overall survival 17.
Median survival 18.
A modest rise in androgen receptor expression, with no mutation, is shown to be necessary and sufficient for antiandrogen resistance and to turn antagonists into agonists, which is the argument that produced abiraterone and enzalutamide.
TAX 327 gave median survival of 18.9 months with three-weekly docetaxel against 16.5 with mitoxantrone, and improved pain and quality of life; SWOG 9916 reported 17.5 against 15.6 months in the same issue. The end of therapeutic nihilism in castration-resistant disease.
Advanced prostate cancer; 150 mg for locally advanced
Metastatic prostate cancer with LHRH analogue
Visakorpi found androgen receptor gene amplification in 7 of 23 tumours recurring on androgen deprivation and in none of the pre-treatment samples from the same men. Chen showed in 2004 that receptor overexpression alone is necessary and sufficient to convert sensitive disease to resistant, and turns antagonists into agonists.
In the same year as the amplification finding, ligand-binding-domain mutations that let progesterone, oestrogen and the antiandrogen itself switch the receptor on are found in 5 of 10 androgen-independent cancers, the second of the five routes out of castration.
Acute non-lymphocytic leukaemia in adults (combination); later hormone-refractory prostate cancer pain (with corticosteroids) and multiple sclerosis
Stamey measured the antigen in 2,200 samples from 699 patients: it tracked tumour volume, fell to undetectable after prostatectomy with a half-life of 2.2 days, and detected recurrence. The same paper warned that it is raised in benign prostatic hyperplasia and is not specific.