A male figure lifts his shirt to reveal a hopeful sun with emanating rays. Guiding hands surround him

Credit: Sèbastien Thibault

If you are a man living in a high-income country, there is no malignancy you are more likely to get than prostate cancer. Advances in diagnosis and treatment have seen the mortality rate in the United States halve from where it was in the 1990s. But people affected still face considerable physical and mental distress, leading many researchers to take up the challenge of improving care.

Some scientists have set their sights on improving the detection of prostate cancer. The search for biomarkers in blood and urine that could augment or replace the troubled prostate-specific antigen test has yielded several promising options. Adjustments to how and when prostate biopsies are performed could help to prevent unnecessary interventions and reduce the risks associated with the procedure. And efforts are being made to increase participation in screening. This is especially important because prostate cancer is very treatable if caught early: in the United States, nearly all of those diagnosed before the disease has spread beyond the prostate gland will survive for at least five years. Once the cancer has moved to other parts of the body, the prognosis is worse. Even in those cases, however, advances in imaging and treatments are delivering fresh hope.

Treatment options for prostate cancer could yet expand further. Immunotherapy, so far employed with only limited success against prostate tumours, continues to be pursued with vigour. A class of drug that weaponizes cells’ inbuilt recycling machinery could provide yet another possibility. Such developments are welcome, as current therapeutic mainstays introduce an array of side effects. Drugs that block testosterone signalling, for instance, are thought to increase the risk of cardiovascular disease. Development of treatments will not be sufficient to help everybody: tackling the implicit bias experienced by Black people is also crucial. And mounting evidence that shows men who have sex with men experience worse outcomes from prostate-cancer treatment than do others must also be acted on.

We are pleased to acknowledge the financial support of the Janssen Pharmaceutical Companies of Johnson & Johnson in producing this Outlook. As always, Nature retains sole responsibility for all editorial content.