The Evolving Landscape of Prostate Cancer Care

Prostate cancer is the second most commonly diagnosed cancer in men, and GLOBOCAN estimated that there were over 1.4 million newly diagnosed cases in 2020. The incidence of prostate cancer is much higher in high-income “developed” countries, but the mortality rates are comparatively higher in low- to middle-income “developing” countries. This is in part due to the cancer being diagnosed at a later stage where treatments are more difficult and less effective. In South Africa, prostate cancer overtook basal cell carcinoma as the most commonly diagnosed cancer in men. South Africa has many of the same problems as many other LMICs (low- and middle-income countries) when it comes to prostate cancer. Prostate cancer screening used to be limited to digital rectal exams and prostate biopsies with the ability to test blood samples for the presence of prostate serum antigen (PSA) only being recently available in many countries and of limited utility. However, the identification of new biomarkers, the use of AI (artificial intelligence), and the combination of imaging techniques and biopsies promise to revolutionize the speed, accuracy, and availability of screening for prostate cancer. At the same time, advances in the treatment of prostate cancer have occurred in every treatment option, with new surgical procedures, new radiopharmaceuticals and radiotherapy techniques, new chemotherapeutic drugs, the increased application of immunotherapy, and better understanding of the mechanisms underlying castration resistance. At the same time, there has been an acknowledgment of the important role played by integrative medicine in ensuring that patients undergoing treatment or those that have survived treatment have a good quality of life and as such these interventions must ensure the patients’ psychological well-being as well as their ability to deal with any physiological changes or alterations that have resulted from either the disease or the treatment. This chapter serves as a basic introduction to the concepts which will be covered in the chapters of this book.