The high variability of prostate cancer Treatment

Written By: Aidan Abney

June 27 2026

In the common culture and literature of oncology, Prostate Cancer treatment has always remained significantly difficult to manage. One of the more reliable sources of Prostate Cancer treatment, which most men in their late 40s to 50s often undergo, is PSA testing (Prostate-Specific Antigen testing).  PSA testing is a blood-based biomarker test that measures the levels of the prostate-specific antigen (PSA) in the blood. It helps detect tumor growth in the Prostate. This has long been a recommended treatment approach because Androgen receptors are closely associated with tumor growth and dynamics, enabling accurate monitoring of PSA levels.  

Regardless, there are many limitations.  As mentioned in the first sentence of the first paragraph, Prostate Cancer treatment is always defined by its challenges.  For one, the length of time for PSA levels to actually drop, known as a “nadir,” takes from around 6 to 12 months, which prevents critical evaluation of early-stage treatments and plans that may address patients’ unwielding negative response(s) to previous treatments. Patients with poor prognostic outcomes tend to be less affected, and those who are at high risk require more extensive therapies. 

In recent times, researchers have looked into molecular mechanisms, with the addition of different chemotherapy techniques, to detect early signs of metastatic prostate cancer. A recent study, known as the PARADIGM study (Plasma Analysis for Response Assessment and to Direct the Management of Metastatic prostate cancer), was conducted to analyze whether ctDNA (circulating tumor DNA), when detected early in metastatic prostate cancer, was at least mildly or purely successful in predicting patient outcomes. These patients were first picked from a pool of those starting off with doublet therapy, a treatment plan that combines two drugs via chemotherapy, in this case: Docetaxel, one of the most common chemotherapy medications, and Androgen Receptor Pathway Inhibitor (ARPI), a hormone therapy treating metastatic prostate cancer.

Using blood samples and a sequencing panel called PCF-Select, the researchers found that ctDNA showed a linear relationship with survival.  Among individuals who were ctDNA-positive, the 24-month survival rate was around 50%, whereas those who were ctDNA-negative had an 85% survival rate. The researchers had concluded that ctDNA was more responsive and significantly better at predicting survival than PSA testing. After this research was published, the medical community has now granted a major breakthrough in how to manage advanced prostate cancer, and the promising nature of the publication will also lend to much faster intervention, meaning advanced prostate cancer will soon become easier to detect at the smallest stages. 

Despite the restrictions that this new type of treatment poses, especially with how expensive it already is, and the complexity of prostate cancer, which is not conducive to ctDNA but rather specific gene deletions like PTEN and RB1 that are less common in detection, as well as resistant clones, there will also be positives. CtDNA testing will be distributed across larger cohorts and combined with PSA testing to improve predictive accuracy. When cycles are focused on 3 or 4, they can be hunched down to as early as cycle 1. Other measures will be made more extensive and efficient, and ctDNA testing will be made adaptable across different treatment types. The future of ctDNA testing lies in its precision. That’s where the field of Oncology is headed: toward incredible technological optimizations and improved patient outcomes.

Source to study:

Jayaram, A., Rashid, M., Reid, A.H.M. et al. Combined ctDNA and serum PSA for dynamic monitoring of metastatic prostate cancer starting first-line treatment: a prospective national cohort study. Nat Cancer7, 915–927 (2026). https://doi.org/10.1038/s43018-026-01172-9