Fifteen Years of PCa Treatment Progress - and the next 15 Years

Fifteen years ago, a prostate cancer diagnosis came with two immediate options: radical prostatectomy or external beam radiation. Both were effective-ish, depending on the stage. Both also carried an unspoken agreement: you might live, but sex and continence would be sacrificed to the gods of early detection.

Back then, imaging was vague, biopsies were random, and “watchful waiting” was medical code for “let’s hope you die of something else first.” PSA testing was under fire for causing too much anxiety, even though it was pretty much the only early warning system anyone had. You got the diagnosis, then you played Russian roulette with your treatment options. If you were lucky, you just lost your erections. If you weren’t, you got a colostomy bag and a second opinion that started with “we should’ve...”

Now? Now it’s different.

First off, diagnostics have become smarter. We have multiparametric MRIs that can actually see what they’re poking at, instead of stabbing blindly into the gland like it owes someone money. We’ve got PSMA PET scans that can light up cancer cells with eerie precision. Biopsies are now targeted, not just twelve random cores taken like shotgun pellets. It’s a small miracle: we can now diagnose the thing without also maiming you in the process.

As for treatment—yes, it still sucks, but it sucks with options. External beam radiation has gone from daily carpet bombing to finely tuned, image-guided precision hits. Intensity-Modulated Radiation Therapy (IMRT), Stereotactic Body Radiation Therapy (SBRT), and brachytherapy now deliver a one-two punch with fewer side effects. Fewer, not none. Your rectum and bladder may still file complaints, but at least they don’t need trauma counseling.

Then there’s hormone therapy. Fifteen years ago, androgen deprivation therapy (ADT) mostly meant Lupron—a shot that turned off your testosterone like flipping a breaker and hoped you wouldn’t completely unravel. Today, we’ve got Firmagon (degarelix), Orgovyx (relugolix), and second-generation anti-androgens like darolutamide, enzalutamide, and apalutamide. They’re more targeted, work faster, and are being combined in smarter ways to delay resistance. You still get hot flashes, brain fog, and emotional volatility that makes you cry at insurance commercials—but again, you live longer. Progress.

We’re not just nuking the cancer anymore. We're stratifying risk, tailoring treatment, and using genetic testing—BRCA mutations, for example—to guide whether someone should get additional therapies like PARP inhibitors. PARP inhibitors, by the way, didn’t even exist in this space 15 years ago. Now they’re giving guys with aggressive mutations a fighting chance. And let's not forget immunotherapy, which is inching its way into prostate cancer’s rigid walls. Sipuleucel-T was the first, and newer agents are being tested in combo trials as we speak.

So yes, I’ve had the scans, the needles, the seeds, the shots. I’ve joined the ranks of hormone-suppressed men trying to remember what it felt like to have a functioning endocrine system. I take magnesium for the cramps, fiber for the guts, calcium for the bones, and naps—frequent, unscheduled naps—for the fatigue.

But here’s the thing: I’m still here.

I’ve seen the needle move. Not fast enough. Not far enough. But enough to know that if the next ten years improve as much as the last fifteen, prostate cancer might finally lose its grip as the king of “you’ll probably die with it, not from it” apathy. We’ll be diagnosing it earlier, treating it smarter, and maybe—just maybe—preserving more of what makes us feel human in the process.

Fifteen Years From Now: My Wishlist, Should I Still Be Around (or Preserved in a Pickle Jar)

Now, let’s look ahead—because if I’ve learned anything, it’s that prostate cancer doesn’t quit. Here’s what I’d like to see in the next 15 years:

- A treatment that works without trashing testosterone. Imagine that, eradicating cancer cells without turning your body into a tepid, estrogen-soaked fog of hot flashes, belly fat, and mood swings. I’d like to fight cancer without also becoming a moody character

- Permanent remission that doesn’t mean permanent side effects. Let me keep my continence, my libido, and my brain. Or at least two out of three. Actually, no—just the brain. I can live without the other two if I can remember why.

- A diagnostic test better than PSA. PSA is useful but vague. It rises if your prostate sneezes. Give me a test that actually distinguishes between “harmless lump” and “you're screwed.” Something you can rely on before a biopsy turns your gland into Swiss cheese.

- Real prevention. Not “eat more broccoli” or “avoid bacon if you want to live.” I want vaccines. I want risk profiling by age 40. I want a world where men don’t find out they have prostate cancer from a random blood test in their 60s—they know before it ever takes root.

Psychological support that’s not a pamphlet. If you chemically castrate a man and irradiate his pelvis, maybe toss in more than a printout about yoga and breathing exercises. Some guys need therapy. Others need a support group. Some just need to scream into the void. Make room for all three.

- A cure. Yeah, I said it. Go big or go home. Not “managing,” not “slowing,” not “chronic condition.” I want them to use the C-word, and not the one that gets you kicked out of dinner parties.

So here’s to the next 15. I hope the men who follow us have it easier. I hope the doctors keep innovating. I hope the drug companies stop price gouging. And most of all, I hope that somewhere out there, a research team is building a future where prostate cancer isn’t a life sentence—or a 15-year science experiment on unwilling participants like me.

And if I’m still here in 2040, I’ll be the cranky old guy in the back of the support group, asking: “What took you so damn long?”