Key takeaways about prostate cancer:
- Prostate cancer is the second most common cancer diagnosed in men across the globe; the risk increases with age.
- When caught early, prostate cancer is highly treatable.
- Because early-stage disease often causes no symptoms, regular prostate-specific antigen (PSA) screening can be critical.
- Not all prostate cancers behave the same way. Some tumors grow slowly, while others are more aggressive.
- Johnson & Johnson is helping advance more personalized prostate cancer care through targeted therapies, genetic insights and innovative immunotherapy approaches.
Bob Lane felt like a healthy 59-year-old when he was diagnosed with prostate cancer “quite by accident,” as he puts it.
In 2014, while he was being treated for something unrelated, his primary care physician ordered a PSA test, a simple blood check to measure prostate-specific antigen—a protein produced by the prostate gland that can help doctors monitor prostate health. Typically, PSA levels above 3 or 4, depending on a man’s age, are considered abnormal and warrant monitoring or further investigation.
Lane’s was 7.5.
His doctor thought it might be a mistake given that just five months earlier, during his annual physical, his PSA was 1.3. Out of an abundance of caution, Lane had his PSA checked again. In just two weeks, it climbed to 10.5.
“It became clear very quickly that it was not a mistake,” says Lane, now 71. “I likely had prostate cancer, even though I had absolutely no symptoms.”
Lane’s experience is not unique. Prostate cancer often causes few or no noticeable warning signs. It’s one of the reasons tracking PSA over time is so important, says Charles Drake, M.D., Ph.D., Vice President, Prostate Cancer and Cross Cancer Immuno-Oncology, Johnson & Johnson.
“This biomarker gives us a sense of both disease progression and how aggressive it may be,” says Dr. Drake. The faster the PSA climbs over time, the more likely it is that the cancer is aggressive.
The rapid rise in Lane’s PSA levels led to additional testing, biopsies and, ultimately, a prostate cancer diagnosis. He underwent surgery to remove his prostate, and because the cancer had not spread beyond the prostate and the surgical margins were clear, his urologist was optimistic that all of the cancer had been removed. Still, he recommended PSA testing every three months.
In mid 2017, follow-up tests showed the cancer had returned. It progressed slowly for several years before becoming more aggressive in 2021, when scans detected a metastatic lesion in Lane’s C1 vertebra, located at the top of the spine. The tumor was successfully treated with nine days of radiation therapy.
Lane then began combination treatment with androgen deprivation therapy (ADT), which blocks the production of testosterone—the hormone that “feeds” prostate cancer and makes it grow—and a drug called an androgen receptor pathway inhibitor (ARPi) to prevent the small amount of testosterone left behind from hitting the tumor cells.
At first, the diagnosis and treatment plan felt overwhelming. “My mind immediately went to the worst place,” says Lane. “I heard Stage 4 cancer and thought, ‘I’m going to die.’”
However, while prostate cancer is the second-leading cause of cancer death in American men (behind lung cancer), most men diagnosed with the disease don’t die from it. This is largely because prostate cancer is highly treatable when detected early, and innovations are expanding options for those with more advanced disease.
We spoke to Dr. Drake to learn the facts about prostate cancer, as well as how Johnson & Johnson is working to better understand the unique characteristics of each patient’s disease and help guide treatment decisions.
1.
Prostate cancer occurs when cells in the prostate—the walnut-sized gland in the male reproductive system that produces fluid to nourish and protect sperm—grow uncontrollably and form tumors.
After skin cancer, it’s the most common cancer diagnosed in men globally, and risk increases with age. In fact, age is the most important risk factor. For men under age 39, the risk is about one in 20,000. Between ages 40 and 59, that risk jumps to one in 45 men. For those ages 60 to 79, around one in seven will be diagnosed.
At the same time, the incidence of prostate cancer appears to be rising among younger men, though researchers don’t yet know why, says Dr. Drake.
“Nearly all prostate cancer will respond to lowering testosterone with androgen deprivation therapy,” says Dr. Drake. “It’s one of the most effective treatments in all of oncology.”
But not all prostate cancers behave the same. Some tumors are slow-growing; others are aggressive. In addition to tracking PSA to help determine how aggressive a tumor is, genetic testing can provide important clues. For example, mutations in BRCA1 and BRCA2 are associated with more aggressive disease and can influence treatment decisions, explains Dr. Drake.
When prostate cancer is diagnosed, doctors use biopsy results and imaging to determine where the cancer is located and whether it has spread. Stages 1 and 2 mean the cancer remains confined to the prostate. Stage 3 means it has grown beyond the prostate or into nearby tissues. Stage 4 is metastatic, meaning the cancer has spread to distant lymph nodes, bones or other organs.
Understanding the stage and grade (how aggressive the cancer appears) helps doctors determine when treatment is needed and which approach is most appropriate.
2.
Like many cancers, early detection is one of the most important factors in prostate cancer outcomes. When the disease is diagnosed while it’s still localized to the prostate, it’s often curable. If it spreads to other parts of the body (metastatic prostate cancer), a cure is usually no longer possible.
The good news is that detecting prostate cancer in its earliest stages can be relatively straightforward, thanks to PSA testing.
Current guidelines suggest men discuss a baseline PSA test with their healthcare provider between ages 45 and 50, followed by regular screening every two to four years for most men 50 to 69 years of age. Some men may need to begin earlier. African American men, for instance, tend to develop prostate cancer at younger ages, and the disease is often more aggressive than it is in other populations, says Dr. Drake.
“If there’s a family history, you should start checking PSA five years earlier than your relative was diagnosed,” he adds.
While early-stage prostate cancer is typically asymptomatic, there can be warning signs:
- Urinary changes, including difficulty starting urination, weak or interrupted urine flow, pain or burning during urination; difficulty emptying the bladder; frequent urination (especially at night); or blood in the urine or semen
- Pain in the back, hips or pelvis that doesn’t go away
- Painful ejaculation
These symptoms can also be caused by other conditions, so it’s important to talk with your healthcare provider if you experience them.
Dr. Drake also urges patients not to panic if a PSA result comes back elevated.
“There’s no low PSA level at which you can’t have cancer, and there’s really no high level at which you definitely have cancer,” he says.
Inflammation and benign prostatic hyperplasia (an enlarged prostate) can also cause PSA levels to rise. What matters most is the trend over time. In general, a stable PSA over many years is reassuring, underscoring the importance of regular monitoring.
3.
In many ways, prostate cancer diagnosis and treatment is one of medicine’s biggest success stories.
Patient outcomes illustrate just how far prostate cancer care has advanced, though survival continues to vary substantially by stage at diagnosis.
Decades ago, a prostate cancer diagnosis carried a much higher risk of death than it does now. In the 1960s, for instance, 50% to 60% of men diagnosed with prostate cancer in Northern Europe died within five years. By 2016, the five-year relative survival had risen to almost 94% in Sweden and around 92% in Finland. In the U.S. today, five-year relative survival is greater than 98% when prostate cancer is diagnosed before it has spread to distant parts of the body.
This progress reflects earlier detection through PSA testing, advances in imaging technologies such as CT scans, MRI and bone scans and significant improvements in treatment options.
“ADT is quite effective,” says Dr. Drake. “I’ve seen patients come in with a PSA of 800, with metastatic disease everywhere. You give them a drug that lowers testosterone, then add an androgen receptor pathway inhibitor to further block cancer cells from getting their fuel source, and that PSA can drop to less than 1 within two months.”
Although a sharp PSA decline can signal treatment response, it doesn’t indicate a cure; ongoing monitoring is still needed.
For patients whose cancer progresses despite ADT, chemotherapy is the standard of care.
There’s also a new treatment called radioligand therapy, which targets prostate-specific memory antigen (PSMA) on cancer cells and delivers radiation directly to the tumor. “This drug was a big advance, because it is generally better tolerated than chemotherapy,” says Dr. Drake.
Another promising area: immunotherapy.
Several years ago, a class of medicines called T-cell engagers began showing potential in prostate cancer in early clinical studies. One part of the molecule binds to a tumor cell, while the other recruits and activates immune cells called T cells to attack the cancer.
“These drugs were a really important proof of concept that prostate cancer can be susceptible to immunotherapy,” says Dr. Drake.
A Johnson & Johnson-developed T-cell engager targeting a prostate cancer-specific antigen has shown promising results in Phase 3 clinical trials. “If approved, this therapy could be one of the biggest advances in prostate cancer in the last 20 to 25 years,” says Dr. Drake.
4.
As with any cancer diagnosis, the emotional impact on patients and their families can be immediate.
Many patients understandably equate cancer with an imminent death sentence, says Dr. Drake. “But then I’m able to say, ‘Listen, hormonal therapy works. Chances are you’re going to do well,’” he says. “And that’s an incredible relief.”
At the same time, treatment side effects—including fatigue, reduced libido, erectile dysfunction, loss of muscle mass, weight gain and hot flashes, as well as an increased risk of cardiovascular events—can affect quality of life and place strain on relationships.
While some effects cannot be fully reversed, others can be managed through lifestyle changes, says Dr. Drake. A healthy diet and strength training, for example, may help offset weight gain and muscle loss.
More than a decade after his diagnosis, Lane says he’s learned to live well with the disease.
“As long as the ADT I take keeps working and the cancer stays sensitive to it, the clock doesn’t feel like it’s ticking,” he says. “I’m proof that Stage 4 cancer can stay at a standstill with the right drugs. All I need is for those drugs to keep working and my mind and body to keep tolerating the side effects.”
5.
Precision medicine is among the most promising areas of prostate cancer research.
One important advance is genetic testing, which can identify alterations that may influence treatment decisions, including mutations in homologous recombination repair (HRR) genes, such as BRCA1 and BRCA2.
“In these cases, patients should get a PARP inhibitor,” says Dr. Drake. “That’s one of our most important personalizations currently available.”
Another potential treatment involves patients with metastatic disease who may be eligible for radioligand therapy targeting PSMA.
“We do a PSMA-PET scan to determine whether a patient’s tumor expresses enough PSMA to qualify for treatment,” says Dr. Drake.
Researchers are also exploring new opportunities for precision medicine. One involves patients whose tumors have lost PTEN, a tumor suppressor gene associated with aggressive disease and treatment resistance.
Dr. Drake is equally optimistic about the future of combination therapies. He sees potential for immunotherapies to be paired with antibody-drug conjugates (ADCs), targeted medicines that link a tumor-seeking antibody to a potent cancer-fighting drug.
“These antibody-drug conjugates are like concentrated chemotherapy, dragging the chemo right to the tumor,” says Dr. Drake. The hope is that combining ADCs, immunotherapy and hormone therapy will lead to even better outcomes.
“For prostate cancer, we’re hopeful that three different mechanisms—antibody-drug conjugates, immunotherapy and hormone therapy—will one day cure people,” he adds.
