With nearly 50,000 new cases each year in France, prostate cancer is the most common cancer in men. In the majority of cases, it progresses slowly, sometimes without ever requiring treatment. But some forms become aggressive and spread silently, complicating treatment. Long debated, screening remains a sensitive subject, between expected benefits and risks of overdiagnosis. The treatments are becoming more precise, without being systematically intensified.
Current medicine no longer seeks to intervene at all costs, but to target well. At the same time, researchers are exploring new therapeutic avenues, from molecular biology to gene editing. Where are we in 2025? What should we remember about this cancer that is so widespread, but so contrasting? To better understand current practices and future developments, we interviewed Dr. Ilan Darmon, Radiation Oncologist at the H. Hartmann Institute of Radiotherapy and Radiosurgery.
A discreet but common cancer
Prostate cancer is the most common in men. It mainly affects people after the age of 50, and remains silent for a long time. Some cancers grow slowly, others become aggressive and metastatic. This contrast makes screening difficult.
The tumor begins in the prostate, a gland the size of a walnut. Adenocarcinoma is the most common form. Symptoms appear late: urinary problems, bone pain, fatigue. PSA measurement and rectal examination are the basic examinations. But PSA can be elevated without cancer, or normal despite a tumor.
Dr. Ilan Darmon reminds us: “ Mass screening is not recommended in France because it has not shown a reduction in the risk of death from prostate cancer. The challenge is to better target the population to be screened and to avoid the risks of overdiagnosis. “.
He specifies that the benefit/risk balance remains unfavorable without appropriate selection. Discussion between doctor and patient therefore remains essential. In practice, a man without a history or symptoms does not need a systematic annual PSA, unless specifically indicated.
Targeted screening is becoming clearer
The days of “blind” screening therefore seem to be over. Today, we favor a more personalized approach. The PSA remains the starting point. According to Dr. Darmon, after an elevated PSA or an abnormal rectal exam, a multiparametric MRI is systematically requested to refine the indication. This approach limits unnecessary biopsies, which remain invasive procedures. He emphasizes that life expectancy is now a determining criterion in the indication for screening, in order to avoid unnecessary treatments in the long term.
“ Target population: men between 50 and 74 years old, with an estimated life expectancy of more than 10 years, or from 45 years old in the event of a genetic mutation or family history “. Blood tests are emerging (PHI, 4Kscore), and liquid biopsy – capable of detecting circulating tumor DNA – raises great hopes. Tomorrow, it could complete or replace certain invasive steps.
A study published in 2025 shows that organized screening allows a 13% reduction in specific mortality over 23 years. Modest but significant, this result rekindles the interest in reasoned screening. Prostate cancer screening therefore becomes more strategic: guided by risk, adapted to the profile, integrated into an individualized prevention logic.
A discreet revolution in treatments
The treatment of prostate cancer is still based on surgery, radiotherapy and hormonal therapy. But their use is becoming more selective, depending on the risk profile. In localized low-risk forms, active surveillance is increasingly offered. For high-risk or recurrent forms, hormonal therapy and radiotherapy are often combined.
Dr Darmon distinguishes two situations concerning enzalutamide, a powerful anti-androgen: “In cancers at high risk of recurrence, the ENZARAD trial has not yet shown a clear indication for adding enzalutamide to radiohormonotherapy. On the other hand, in patients with a non-metastatic biological recurrence with a rapid doubling of PSA, the effectiveness of this combination has been demonstrated. The FDA recommended it in this situation “. He specifies that decisions also take into account side effects and quality of life. Too intensive treatments can permanently impair sexual or urinary function.
The major innovation also comes from imaging. A study published in October 2025 in Journal of Nuclear Medicine demonstrated the interest of Whole-Body SPECT, a high-sensitivity 3D scan capable of continuously monitoring bone tumors. This technique detects micro-metastases invisible to standard examinations, and monitors their evolution day after day. By offering precise, dynamic and minimally invasive mapping, it opens the way to better targeted, more responsive and potentially personalized treatments. A promising advance in the monitoring of metastatic prostate cancer.
New avenues that intrigue researchers
Beyond validated treatments, research is moving into new areas to better understand — and better target — resistant forms of prostate cancer. Several experimental approaches seek to overcome the current limits of hormonal therapy or to restore its effectiveness in advanced forms.
The thyroid TRβ receptor, in particular, is attracting strong interest. “ The TRβ receptor acts as a tumor suppressor. Preclinical data suggests that it may reduce proliferation, restore sensitivity to antiandrogens, and improve response to radiotherapy. Its combination with enzalutamide is a serious avenue for years to come
», explains Dr Ilan Darmon.
Furthermore, gene editing by CRISPR-Cas9 opens up new perspectives. Researchers have identified, through a CRISPR screen, a chaperone protein (PTGES3) playing a key role in the activation of the androgen receptor. Its suppression could increase sensitivity to hormonal treatments. “
CRISPR could also have a radiosensitizing effect. But today, these approaches still remain at the exploratory stage. », recalls the clinician.
Other strategies aim to circumvent resistance by targeting BRCA or ATM mutations, or by reactivating DNA repair mechanisms. Inhibitors of these pathways are being tested in combination with radiotherapy.
Finally, parallel avenues are emerging: mRNA vaccines, antioxidants such as grape seed extracts, or even metabolic agents blocking tumor growth. The results remain preliminary, but demonstrate strong dynamism.
The medicine of tomorrow will no longer rely solely on hormones. It multiplies the angles of attack, often complementary, to counter a disease which too often evades traditional treatments.
Precision medicine under construction
Prostate cancer is no longer considered a single block. It is a family of diseases, guided by varied biological profiles. BRCA1/2 mutations or DNA repair defects (HRR, HRD) are now sought in metastatic or resistant cases. They can guide therapeutic choices.
“ PARP inhibitors (such as Olaparib, Talazoparib, Niraparib) are already used in breast or ovarian cancers. In the prostate, their effectiveness has been demonstrated regardless of the mutational status, but the presence of mutations improves the response. This may influence the strategy in metastatic patients, after failure of new generation hormonal therapy “.
Dr. Darmon emphasizes that these treatments require access to sequencing platforms and multidisciplinary expertise. They are not yet available everywhere.
Tomorrow, the combination of genomics, artificial intelligence and advanced imaging will make it possible to adapt treatment to the millimeter. The objective: to offer the right molecule, at the right dose, to the right patient. This shift towards precision oncology has begun. And it could well permanently change the way we think about cancer.
With an unwavering passion for local news, Christopher leads our editorial team with integrity and dedication. With over 20 years’ experience, he is the backbone of Wouldsayso, ensuring that we stay true to our mission to inform.
