Prostate cancer

Carcinoma prostatae · Rakovina prostaty

male only

What it is

The commonest male cancer; often so slow that watching beats treating.

call 112 / 911 now Sudden leg weakness, numbness or loss of bladder or bowel control
call 112 / 911 now Unable to pass urine at all
see a doctor soon New back or bone pain that does not go away
see a doctor soon Blood in urine or semen, or weak stream getting worse

Active surveillance for low risk — 15-year survival the same as surgery in the ProtecT trial, though spread was about twice as common (9% vs 5%) trials support
Prostatectomy — same survival as monitoring in that trial, with incontinence and impotence as the cost mixed evidence
Radiotherapy — same trade-off, different side effects mixed evidence
Androgen deprivation in advanced disease trials support
Abiraterone or enzalutamide when it spreads trials support
Lutetium-177 PSMA-617 (Pluvicto) — approved 2022 (FDA, EMA) for PSMA-positive spread after hormone therapy and chemotherapy; about 4 months' longer survival in VISION trials support

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

Low-fat plant-based diet (Ornish) — a small trial slowed PSA rise early / small studies
Modified citrus pectin — small studies of slower PSA doubling early / small studies
Pomegranate juice — early trials were hopeful; a placebo-controlled trial found no difference not confirmed in trials
Selenium and vitamin E (SELECT trial) — no prevention, and vitamin E raised the risk not confirmed in trials
Fenbendazole and ivermectin — anecdotal; no human trials anecdotal / traditional