Prostate cancer treatment in Israel is renowned for its advanced technologies and expert oncology teams. At our Tel Aviv medical center, we offer state-of-the-art diagnostic and treatment options for prostate cancer patients with leading prostate cancer specialists in Tel Aviv.
Our Tel Aviv prostate cancer center is known for advanced imaging, personalized treatment plans, and a patient-centered approach, ensuring the highest standard of oncological care in Israel.
What is Prostate Cancer, Its Causes, and How It Is Treated?
The prostate is a small gland found in men, located just beneath the bladder. During the reproductive years, it plays an important role by producing part of the seminal fluid that nourishes and transports sperm.
However, the prostate can also be the source of various medical issues. The most common problem, especially among older men, is benign prostatic hyperplasia — a non-cancerous enlargement of the gland that can sometimes lead to difficulty urinating. Another condition that can arise in the prostate is prostate cancer.
Prostate cancer is the most frequently diagnosed cancer among men and stands as the second leading cause of cancer-related deaths in men throughout the Western world.
In Israel, 1 in 6–9 men will be diagnosed with prostate cancer, and in total approximately 2,700 patients are diagnosed each year
The main risk factors for developing prostate cancer are advanced age (prostate cancer is rare under the age of forty, and its incidence increases steadily with age), disease in first-degree relatives (but only in a minority of cases is the family history part of an identified genetic syndrome such as a mutation in the BRCA gene (BReast CAncer gene)), lack of physical activity, and increased consumption of fatty foods.
Diagnosis of prostate cancer in Israel
Due to an early detection screening test by measuring the level of the PSA (Prostate specific antigen) marker in the blood, prostate cancer is diagnosed in most cases (90 percent of cases) at an early stage without metastases, and sometimes without symptoms. The benefit of early detection has not been proven conclusively, and there are differences of opinion regarding this approach. In some cases, the tumor will be diagnosed at an advanced locoregional stage or even with metastases (about 10 percent of cases). Metastases may cause symptoms depending on the organ involved. The bones are the most common organ for metastatic involvement. Symptoms of metastatic prostate cancer include bone pain, weight loss, loss of appetite, and urinary tract obstruction.
The prostate cancer diagnosis process includes a doctor’s examination (especially a digital exam to assess the prostate), a blood test for the PSA marker level, a prostate biopsy, and imaging tests. The biopsy will sometimes be guided by an MRI (Magnetic Resonance Imaging) of the prostate. Imaging tests sometimes include an MRI of the prostate and a PET-PSMA (Positron Emission Tomography – Prostate-Specific Membrane Antigen) test to diagnose or rule out the presence of metastases.
Early-Stage Prostate Cancer Treatment in Tel Aviv
Prostate cancer that is detected at an early stage is often curable, and most patients will not die from their disease. There are a variety of approach options, including prostatectomy, and radiation therapy to the prostate (and in some cases to the pelvis, with or without hormonal therapy). In some patients, active surveillance without treatment is an option. Other treatments that are sometimes given are brachytherapy (treatment by implanting radioactive seeds in the prostate), HIFU (High-Intensity Focused Ultrasound, destruction of tumor tissue by heating), cryotherapy (destruction of tumor tissue by freezing), and photodynamic therapy (Photodynamic therapy) (Tookad).
Considerations taken into account in determining the appropriate treatment are the patient’s age, underlying diseases, PSA level, appearance of the tumor on biopsy (Gleason score), physical examination and imaging findings, and sometimes genomic testing of the tumor tissue.
After the end of initial treatment, the patient will usually be followed up periodically, including a physical examination, PSA testing, and repeated imaging tests as needed.
Approach to disease recurrence after initial treatment
About one-third of patients treated for prostate cancer that was detected at an early stage without metastases will experience disease recurrence after initial treatment.
In the first stage, this recurrence is sometimes manifested as an increase in the PSA level, without evidence of metastases on imaging tests. This condition is referred to as non-metastatic biochemical recurrence of prostate cancer.
Options for approaching this condition include other treatment that has not been previously given (e.g., radiation with or without hormonal therapy after prostatectomy), observation alone, hormonal therapy, or participation in a clinical trial.
In some of these patients, metastases will later develop.
Approximately 20 percent of patients will be diagnosed with metastases at some point in their disease (either at initial diagnosis or later after diagnosis of a nonmetastatic primary tumor).
Approach to Metastatic Prostate Cancer
Approximately 20 percent of prostate cancer patients will be diagnosed with metastases during their disease (either initially or as a recurrence after treatment of a primary tumor that was initially diagnosed without metastases).
Metastatic prostate cancer patients are classified according to several methods, for example, those with regional secondary spread (in the pelvic lymph nodes and lower retroperitoneum) or non-regional; those with few metastases (oligometastatic disease) or many metastases (polymetastatic disease); and those with low or high disease volume (at least 4 bone metastases, including at least one outside the spine and pelvis, and/or visceral metastases).
The therapeutic approach will be determined by the classification of the disease.
The hormone Testosterone (a type of androgen) is involved in the tumor process. Therefore, the initial treatment for metastatic prostate cancer patients is testosterone-reducing hormone therapy (to castration levels with LHRH Agonist (Luteinizing Hormone-Releasing Hormone) injections, LHRH Antagonist injections or pills, orchiectomy.
Until a few years ago, testosterone-reducing hormone therapy was the only initial treatment for these patients.
This treatment results in a good response in most patients, who show a decrease in PSA levels, improvement in symptoms, and improvement or stabilization in imaging tests.
However, after a certain period of time (in some studies, a median time of one and a half to two years), most patients will show disease progression to a castration-resistant state (i.e., disease progression in terms of PSA, symptoms, and imaging tests, despite a low level of testosterone in the blood).
There has been a significant improvement in the understanding of the biology of prostate cancer, and the knowledge gained has led to the development of new treatments that are precisely directed against the molecular mechanisms responsible for disease progression. Receptor activation Androgen is a central process in prostate cancer. The androgen receptor is very sensitive to low concentrations of androgens.
Published studies have shown that adding chemotherapy with the drug Docetaxel, or advanced androgen-blocking hormonal therapy (drugs such as Enzalutamide, Apalutamide, Abiraterone) to primary hormonal therapy significantly delays the time to the development of castration-resistant disease, and improves patient survival. Therefore, most patients with metastatic prostate cancer will be treated initially in addition to primary testosterone-suppressing hormonal therapy, also with Docetaxel chemotherapy and/or advanced hormonal therapy.
Approach to advanced metastatic castration-resistant prostate cancer
Most metastatic prostate cancer patients treated with initial hormonal therapy will develop resistance to the initial hormonal therapy and disease progression after some time (on average several years) despite low serum testosterone levels. This condition is known as metastatic castration-resistant prostate cancer or mCRPC.
mCRPC is a common and complex clinical issue.
In the second decade of the 21st century, progress has been made in understanding the molecular mechanisms involved in the progression of metastatic castration-resistant prostate cancer, and this understanding has led to the development and approval of drugs that have expanded the treatment horizon for these patients.
Prostate cancer treatment in Israel
Oncological treatments for this condition (depending on what the patient has received in the past) include:
- Chemotherapy (the drugs Docetaxel and Cabazitaxel)
- Advanced hormonal therapies Androgen inhibitors (the drugs Abiraterone Acetate, Enzalutamide)
- Biological therapies (the drugs Olaparib and Rucaparib) that inhibit the protein PARP (Poly ADP Ribose Polymerase, a DNA repair protein). This treatment is suitable for patients with genomic alterations in tumor tissue in DNA repair proteins such as BRCA2
- Radioisotopes (the drugs Radium 223 dichloride and Lutetium 177 PSMA (Prostate-Specific Membrane Antigen)) which are intravenous treatment with an isotope that decays while emitting radiation that damages the metastatic tumor cells (Alpha radiation in the treatment of Radium 223 dichloride, Beta radiation in the treatment of Lutetium 177 PSMA)
- Immunotherapy (with the drug Pembrolizumab (Keytruda)) in a small minority of patients with MSI (Microsatellite instability) genomic alterations in the tumor tissue
Treatment by a multidisciplinary team
Treatment of prostate cancer is complex. Therefore, one should strive to treat it within the framework of a hospital where each case is discussed and treated by a multidisciplinary team that includes oncologists specializing in prostate cancer, urologists, radiation oncologists, pathologists, and imaging doctors.
“Looking for advanced and personalized prostate cancer treatment in Tel Aviv, Israel? Contact our clinic today to schedule your consultation with leading Israeli oncology experts.”
