ADVANCES IN PROSTATE CANCER MANAGEMENT

• Moderator: Prof Ngugi Mungai
• Speakers: Prof Feng Wu, Dr Palanki Satya Dattatreya
• Date: 17 September 2026

This session explored contemporary approaches to prostate cancer management, bringing together advances in systemic therapy with emerging applications of high-intensity focused ultrasound (HIFU).

Dr Palanki Satya Dattatreya focused on the changing systemic treatment landscape across the prostate cancer continuum, particularly metastatic castration-sensitive disease and non-metastatic castration-resistant prostate cancer. He emphasized the importance of moving beyond androgen deprivation therapy (ADT) alone for most patients and considering earlier treatment intensification with androgen receptor pathway-targeted therapies.

A key theme was the need to define disease burden and presentation at the outset. Distinguishing between low- and high-volume disease, and between de novo and recurrent metastatic disease, can help guide treatment selection and provide important prognostic information. The session also reviewed the evidence supporting doublet and, in selected fit patients, triplet therapy, while highlighting the importance of tailoring treatment to disease volume, patient fitness and expected toxicity.

The presentation reviewed the role of next-generation androgen receptor pathway inhibition and highlighted PSA doubling time as an important marker in non-metastatic castration-resistant prostate cancer, helping identify patients at higher risk of developing metastatic disease.

During the discussion, Dr Dattatreya reinforced that treatment decisions should not rely on chronological age alone. Physiological fitness, performance status, comorbidity, expected toxicity and patient preference remain important when deciding how aggressively to intensify treatment.

Prof Feng Wu introduced HIFU as a non-invasive ablative technology that concentrates ultrasound energy within a defined target, producing rapid local thermal injury and coagulative necrosis while avoiding surgical incisions. He reviewed its established and evolving applications in benign prostatic hyperplasia and presented early clinical experience in localized prostate cancer.

His presentation highlighted the precision required for HIFU, including ultrasound or MRI guidance for treatment planning and monitoring. The discussion also addressed one of the challenges of focal treatment in prostate cancer: accurate tumour localisation. Some prostate cancers may not be clearly visible on MRI, making biopsy information important when defining treatment targets and deciding between focal and whole-gland approaches.

Across the session, a consistent message emerged: prostate cancer management is becoming increasingly individualized. Disease volume, stage, biology, patient fitness, treatment tolerance and access to newer technologies all influence the choice and sequencing of therapy. The expanding range of systemic and local treatment options makes multidisciplinary assessment increasingly important in determining the most appropriate pathway for each patient.

Key Takeaways

• ADT alone now has a limited role in many patients with advanced hormone-sensitive prostate cancer, with treatment intensification increasingly central to contemporary management.
• Disease volume, risk and whether metastatic disease is de novo or recurrent should be assessed early because these factors influence prognosis and treatment selection.
• Next-generation androgen receptor pathway therapies have expanded systemic treatment options across metastatic hormone-sensitive and non-metastatic castration-resistant disease.
• Treatment intensity should be individualized according to physiological fitness, disease characteristics and expected toxicity rather than chronological age alone.
• HIFU is a non-invasive local treatment option for selected localized prostate cancers, but accurate tumour localisation is critical.
• Multidisciplinary decision-making remains essential as treatment becomes more individualized.