By Sarah Reynolds

Prostate cancer remains one of the most prevalent malignancies affecting men worldwide. In the UK, prostate cancer is the most common cancer among men, with more than 63,000 men diagnosed every year and around 510,000 living with or after the disease. On average, one in eight men in the UK will be diagnosed with prostate cancer in their lifetime.1 Early detection and therapeutic advancements have led to a decrease in mortality over the last decade. However, a major public health challenge remains in achieving timely diagnosis and optimal patient stratification so men receive interventions tailored to the biology of their disease.

Research by Prostate Cancer UK highlights that many men assume they will be told by their GP if they are at risk, or that screening is already part of routine checks. Many men wrongly believe that a digital rectal examination is necessary, and the invasive nature of the test discourages them from seeking advice. This misconception, alongside stigma and fear, create barriers to early engagement. A large proportion of men will delay acting until symptoms appear, leaving many diagnosed at a later stage, worsening prognosis and limiting options for therapeutic intervention.

Efforts to close this awareness gap are increasing. Public campaigns each November during Men’s Health Month, as well as year-round initiatives from charities and healthcare organisations, are encouraging men to assess their risk earlier and have proactive conversations with their GPs.

At the same time, innovation is beginning to reshape the clinical landscape. Advances such as prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging, radioligand therapies and poly ADP-ribose polymerase (PARP) inhibitors are redefining how clinicians detect and manage prostate cancer, offering new opportunities for earlier, more precise care. The challenge for the pharmaceutical industry is to bridge the educative gap between public awareness programmes and the continually evolving therapeutic landscape, ensuring that men not only understand their risk but also benefit from the advances transforming prostate cancer care.

‘Prostate cancer is the most common cancer among men in the UK, with more than 63,000 men diagnosed every year’

In this article, Sarah Reynolds, Director at Bioscript, explores the current prostate cancer landscape and discusses the necessary shift in thinking for the industry to overcome systemic access hurdles to deliver truly personalised care, highlighting medical affairs’ role in connecting innovation to patient benefit.

For decades, prostate cancer diagnosis and monitoring have relied primarily on prostate-specific antigen (PSA) testing, supplemented by conventional imaging such as CT scans and bone scintigraphy. While PSA trends are valuable in tracking disease progression, they cannot reliably differentiate between low-grade and aggressive disease, nor do they fully guide treatment decisions. This absence of clear molecular signatures or robust predictive biomarkers is the greatest gap in current diagnostic practice.

The emergence of PSMA PET imaging is beginning to change this picture. With superior sensitivity and specificity, PSMA PET can detect metastases that traditional scans may miss, offering a clearer picture of disease spread and biology. This ability to identify even subtle lesions opens the door to more precise patient stratification and treatment selection. In practice, it means clinicians may be able to target radiation to resistant cancer cell populations, delay escalation to more toxic systemic therapies and extend the effectiveness of existing regimens.

Yet despite its promise, PSMA PET is not fully embedded in clinical practice. Access remains uneven and many healthcare systems lack the infrastructure to implement advanced imaging at scale. Currently, clinical validation efforts are currently underway through numerous trials aimed at defining the optimal pathways for integrating PSMA PET into routine clinical practice.

The shift toward precision therapy is vital for managing complex and advanced forms of disease. This is particularly the case for non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC), where clinicians take into account prevention of progression with quality of life, particularly in older, comorbid patient populations.

Over the last decade, both nmCRPC and mHSPC have seen treatment strategies evolve rapidly. In nmCRPC, androgen receptor pathway inhibitor (ARPI)-based regimens have become the primary treatment option, sometimes combined with chemotherapy in suitable patients.

The mHSPC setting tells a similar story of progress tempered by complexity. While androgen deprivation therapy (ADT) remains the backbone, doublet and triplet regimens are now standard considerations. More intensive treatment can extend survival, but it also increases side effects such as fatigue and bone loss. As a result, many oncologists aim to strike the right balance, tailoring therapy rather than simply escalating it. Advanced imaging such as PSMA PET enables metastasis-directed radiotherapy, helping control resistant lesions and extend systemic therapy benefit.
Alongside these refinements, an expanding arsenal of targeted therapies is reshaping the horizon:

• PSMA radioligand therapy, currently positioned later in the disease course, is showing potential earlier on, where it could delay chemotherapy or synergise with ARPIs
• PARP inhibitors are demonstrating particular value in patients with breast cancer gene 1 (BRCA) mutations, reinforcing the importance of genetic testing in guiding treatment decisions
• Immunotherapies, including checkpoint inhibitors and chimeric antigen receptor T-cell (CAR-T) cell approaches, remain largely investigational but hold promise in biomarker-defined populations
• Antibody-drug conjugates and bispecific antibodies point towards new treatment avenues that are less reliant on hormone sensitivity.

The pace of innovation in prostate cancer is accelerating, but the system that surrounds this progress will determine the impact. Advanced diagnostics such as PSMA PET imaging and biomarker testing, alongside targeted therapies like radioligands and PARP inhibitors, are poised to redefine prostate cancer management. However, their full potential can only be realised if healthcare infrastructure and equitable access evolve in step with scientific progress.

PSMA PET imaging, for instance, delivers exceptional sensitivity, yet its availability remains inconsistent, and reimbursement frameworks are still evolving. Similarly, while genetic testing holds promise for guiding the use of PARP inhibitors, its adoption across clinical settings is uneven. For the industry, this means the challenge extends beyond product development into policy engagement and collaboration with healthcare systems to ensure new tools are not just approved but embedded into standard practice.

Education is the thread that connects innovation to patient benefit. Clinicians need education and evidence on how best to sequence therapies, combine modalities and stratify patients based on risk and biology. Patients need accessible information that demystifies testing and treatment, empowering them to make informed decisions. Industry can play a critical role here by continuing to provide the relevant education and training, helping to align multidisciplinary practice within urology, oncology and primary care.

The future of prostate cancer care will not be defined by a single breakthrough, but by the alignment of these elements: awareness that prompts earlier action; diagnostics that enable precision; therapies that extend survival while preserving quality of life, and a collective system that connects them all. Redefining prostate cancer care will require coordinated efforts across research, clinical practice and policy to translate innovation into measurable improvements in patient outcomes, guided by evidence, equity and multidisciplinary collaboration.

Reference:
1. prostatecanceruk.org/for-health-professionals/data-and-evidence

Sarah Reynolds is Director at Bioscript