Understanding the biological mechanisms involved in prostate cancer is key, as these processes allow the tumor to become resistant to hormone therapy. Therefore, it is necessary to define new therapeutic strategies capable of slowing or preventing tumor progression, as highlighted by medical oncologist and communication spokesperson for the Spanish Genitourinary Oncology Group (SOGUG), Maria José Méndez.
When the disease is diagnosed with metastasis, the initial reference approach is hormone therapy, based on androgen suppression or castration. With this treatment, remissions are achieved in practically all patients and, furthermore, for about ten years it has been scientifically demonstrated that adding intensive treatment with chemotherapy and/or new-generation hormonal agents to castration "significantly increases survival".
However, even with these increasingly intensive therapeutic regimens, most patients treated with androgen suppression eventually develop castration-resistant disease, with high mortality and an average survival that, until a few years ago, did not exceed 3 years.
According to the Spanish Network of Cancer Registries (REDECAN), whose data is disseminated annually by the Spanish Society of Medical Oncology (SEOM), it is estimated that in 2026 approximately 34,833 new cases of prostate cancer will be diagnosed in Spain and that in 2024 there were about 6,000 deaths from this tumor.
The majority of prostate cancers are detected in localized stages and, overall, present very high survival rates. However, around 7 percent of diagnoses already show metastasis from the outset and approximately one-third of patients initially diagnosed in the localized stage may progress to an incurable metastatic disease.
Early detection is, therefore, crucial for achieving a cure. Given that it is estimated that 1 in 7 men will develop prostate cancer during their lifetime, specialists advise men without a family history to see a urologist for a first check-up starting at age 50.
Importance of the family component and early screening
Prostate cancer presents marked family aggregation and the risk of suffering from it practically doubles when several first-degree relatives are affected. In men with a family history of this tumor and, especially, in those carrying mutations in cancer predisposition genes such as BRCA, it is especially relevant to recommend early screening (starting check-ups from 40 years of age) due to the increased probability of developing the disease.
According to experts, in these cases, the most appropriate course of action is to refer patients to a Hereditary Cancer Unit, among the many available in the country's Medical Oncology Services, to assess oncological risk in a personalized manner and perform genetic testing when indicated.
Recent advances in available therapies
In recent years, there has been notable progress in prostate cancer treatment options, even tripling survival in the most advanced stages. The approach has shifted from non-specific therapies to targeted treatments, allowing for a much more individualized approach.
The president of SOGUG and coordinator of the Genitourinary Tumor Unit of the Medical Oncology Service at Puerta de Hierro University Hospital in Madrid, Aránzazu González del Alba, highlights that in the last decade, they have had new therapies approved in the context of precision oncology that "have revolutionized the treatment of metastatic prostate cancer."
In the management of metastatic disease, the introduction of drugs targeting specific molecular targets stands out. Among these are PARP enzyme inhibitors, recently incorporated into public funding in Spain, which have shown to improve survival in prostate cancer patients with alterations in the DNA repair pathway, especially mutations in the BRCA1 and BRCA2 genes.
Likewise, other advanced treatments such as Lutetium PSMA have been incorporated, opening "a new era for patients with metastatic prostate cancer, improving survival, delaying tumor progression, and alleviating symptoms such as pain, with a favorable safety profile."
The great challenge in Spain, according to specialists, is to consolidate a multidisciplinary approach to prostate cancer from the initial stages of the pathology. This model "requires the active and coordinated participation in the decisions concerning the diagnosis and treatment of the disease of the main specialists involved (Urologists, Medical Oncologists, and Radiation Oncologists) with the collaboration of Radiologists, Pathologists, Nuclear Physicians, and Geriatricians, among others".
Finally, SOGUG insists that the real implementation of this multidisciplinary approach in all hospitals in the national territory will allow each patient to receive, at each stage of their oncological process, the most appropriate therapeutic alternative. Furthermore, they emphasize that this type of approach from the localized phase "will give the patient the opportunity to access innovation and quality research".