Inside the shifting landscape of prostate cancer care: What clinicians are seeing, using and questioning
Prostate cancer treatment is evolving fast. New technologies are reshaping the way clinicians diagnose and manage the disease. As clinical decisions become more complex, such as choosing between intensifying treatment with newer agents or delaying escalation to preserve quality of life, the gap between what is possible and what is practical is starting to widen.
To understand what’s shifting in prostate cancer treatment, we spoke to several Key Opinion Leaders (KOLs) across Europe and the United States and surveyed 50 more prostate cancer clinicians to understand their challenges and hopes for the future of prostate cancer treatment.
Their responses reveal a complex and evolving picture, one shaped by scientific breakthroughs, shifting clinical roles, infrastructure strain and uncertainty
around treatment sequencing. While innovation is opening doors, clinicians are also grappling with practical and strategic challenges.
Clinical innovation is accelerating
Emerging tools such as prostate-specific membrane antigen positron emission tomography (PSMA PET) are being hailed as the next frontier in prostate cancer diagnostics. “This is where the future of monitoring is headed,” said one clinician in Germany. With the potential to detect subtle, often subclinical metastases more accurately than conventional scans, PSMA PET is already influencing how clinicians approach treatment decisions. However, clinicians consistently cited inconsistent reimbursement and limited access to nuclear medicine departments as key barriers to widespread PSMA PET adoption. These infrastructure and funding challenges mean that, despite its promise, PSMA PET remains out of reach for many centres. Improving equitable access will be critical to unlocking the full potential of this diagnostic innovation.
From a novel therapeutic perspective, combination approaches with targeted treatments, including androgen receptor pathway inhibitors (ARPIs), radioligand therapies and poly ADP ribose polymerase (PARP) inhibitors, are creating new opportunities. Immunotherapies, antibody-drug conjugates and bispecific antibodies are also gaining traction in biomarker-driven subsets.
However, as these options expand, so does the complexity of clinical decision-making.
Real-world application is more challenging
Innovation may be accelerating, but real-world practice is struggling to keep pace. As diagnostics like prostate-specific membrane antigen positron emission tomography (PSMA PET) and an expanding array of targeted therapies reshape the treatment landscape, clinicians are facing growing uncertainty about how best to apply them in practice.
● New tools, old barriers
Adoption of PSMA PET highlights this challenge. While it offers improved sensitivity over conventional imaging, its use depends not just on clinical data but also on reimbursement, infrastructure and policies that vary widely.
● Earlier treatment, unclear pathways
The same is true for radioligand therapy. One KOL from Italy noted, “I would prefer to incorporate it earlier in the disease course, including for patients with
metastatic hormone-sensitive prostate cancer.” Yet questions around sequencing, combinations and patient selection remain unresolved.
● Systems under strain
At the same time, health systems are feeling the pressure. Multimodal treatment plans demand close coordination between specialties, robust imaging capacity and the ability to deliver increasingly complex therapies. However, not all centres have the same access to advanced diagnostics, nuclear medicine infrastructure or streamlined reimbursement pathways, leaving critical resources unevenly distributed.
Implications for pharma
The disconnect between innovation and implementation has implications across the pharmaceutical value chain.
Commercial and medical teams can help address knowledge gaps by supporting clinician education and peer-to-peer exchange, particularly between multidisciplinary teams involving oncologists and urologists. “Ultimately, the urologist is the primary physician that the patient sees regularly. Therefore, I need to collaborate with them rather than work against them,” said one German oncologist, pointing to the need for cross-specialty coordination.
Market access leaders play a vital role in addressing barriers to uptake, such as fragmented infrastructure and reimbursement misalignment, factors that often stall the adoption of promising innovations. At the same time, clinical development teams must align trial strategies with these real-world constraints. Many KOLs expressed a clear appetite for studies that explore sequencing strategies or evaluate novel combinations earlier in the treatment course. Designing trials with these practical realities in mind can increase relevance, uptake and ultimately patient impact.
These efforts are not just supportive but strategic. Closing the gap between what is available and what is actually used will be key to improving outcomes, informing value communication and maximising impact.
The challenge ahead
Prostate cancer care is on the cusp of meaningful transformation that can impact patient outcomes. The findings from our research reveal a field undergoing rapid change, marked by diagnostic innovation, therapeutic expansion, evolving clinical roles and persistent system pressures.
However, no single trend defines the future; instead, it is shaped by a constellation of shifting practices, unanswered questions and clinical ambition.
Success will depend on whether systems, providers and industry stakeholders can close the gap between possibility and practice.
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