Prostate Cancer in Israel Often Requires Active Surveillance Rather Than Immediate Treatment
Prostate cancer is the most common cancer among men in Israel, typically diagnosed after age 60. Recent high-profile cases, including former U.S. President Joe Biden’s metastatic prostate cancer, highlight the disease’s wide variability in aggressiveness and progression. This variability means that the term "cancer" alone does not determine prognosis or treatment strategy; factors such as tumor type, stage, aggressiveness, and spread are critical.
Most prostate cancers in Israel are detected early and asymptomatically, often through a combination of urological exams, PSA blood tests, MRI scans, and biopsies. When symptoms appear, they may include urinary difficulties. For cases suspected of metastasis, PET PSMA imaging is used. Importantly, many early-stage, low-risk tumors are managed with active surveillance rather than immediate treatment to avoid side effects, involving regular monitoring with MRI and repeat biopsies.
For higher-risk localized tumors, treatment options include robotic prostatectomy and radiation therapy, sometimes combined with hormone therapy. Focal treatments targeting specific tumor areas are also considered based on patient and tumor characteristics. The goal for early-stage cancer is often curative.
When prostate cancer has metastasized, commonly to bones causing pain and reduced quality of life, treatment focuses on hormone therapy to block testosterone, which fuels tumor growth. Chemotherapy may be added early to improve disease control. Advances in understanding tumor biology have led to personalized treatment approaches, including advanced hormone therapies, chemotherapy, radioligand therapy, biologics, and clinical trials. Multidisciplinary teams often manage complex cases.
The article emphasizes that prostate cancer is not a uniform disease; treatment and prognosis depend on individual tumor biology and patient factors. Active surveillance is a valid and often recommended approach for many men, underscoring the importance of personalized care rather than fear based solely on the cancer diagnosis.
