In March 2025, the Journal of the American Medical Association (JAMA) published an article titled “Prostate Cancer: A Review.”^[i] It was written by a team of doctors from Seattle, Washington, and it broadly depicted today’s state of the prostate cancer (PCa) world. It included statistics on the disease, it summarized current knowledge about it, and it described today’s approaches to treating the disease at each stage (localized, advanced, and metastatic).

Then, in a July issue’s “Comment & Response” section, JAMA carried two brief articles. The first was a series of questions about the March article, raised by a team of Chinese authors.^[ii] The second was answers to the questions from the original Seattle authors.^[iii] In essence, this amounts to a courteous professional conversation.

I have a hunch that my blog readers rarely have a chance to witness the kind of professional dialogue that journal articles can give rise to. I want to use this blog to share the questions and answers because the Chinese authors identify developments that promise new hope in four current PCa areas:

• early detection
• treating metastatic PCa
• a rare but very deadly type of PCa
• AI as a promising tool

I decided to paraphrase the two articles and structure them into a “Q & A” format. Here goes.

Early detection

Q: Your review described the complexity of prostate cancer, but it seems to us that you underemphasize new screening and diagnostic technologies like liquid biopsy screening to detect circulating tumor cells and tumor DNA. Couldn’t this replace PSA tests that are not specific for PCa and often lead to overdiagnosis and overtreatment?

A: Thank you for taking time to raise thoughtful questions which point to areas beyond the scope of our description of the current clinical world. You are right that we didn’t address developments that are not yet approved for everyday use with patients, and we appreciate the chance to share our views. We agree that liquid biopsy, especially for screening, may have a key role in monitoring the disease and tracking treatment response, but so far, its usefulness for screening hasn’t been established because most patients with early, localized PCa don’t have detectable circulating tumor DNA. Yes, it is promising for this and other uses but more research is needed.

Treating metastatic prostate cancer

Q: Your article presents the current application of androgen deprivation therapy (ADT) for advanced and metastatic disease, but as we know, ADT is not curative and eventually leads to metastatic disease that begins to progress because it has become resistant to ADT. At that stage, the use of nuclear medicines (radioisotopes bonded to PSMA) has shown efficacy in treating PCa that has developed resistance to ADT. Would it make sense to add them earlier in treatment, potentially delaying ADT resistance, thus extending life?

A: Good question. Yes, we agree that combination therapies can help delay ADT resistance, but nuclear treatments, as well as immunotherapies, can have harsh side effects. There are clinical trials going on right now regarding combination treatments, and we eagerly await results. Other strategies also being tested, such as bipolar ADT/high-dose testosterone, etc. were beyond the scope of our article.

Rare but deadly neuroendocrine prostate cancer

Q: Published literature seems to lack much discussion about special or rare types of PCa, such as neuroendocrine PCa. Though it doesn’t occur that often, survival rates are very poor. Do you know of new studies or clinical trials testing effective treatments for this type?

A: Well, you’re correct this is an area of much interest but there remains uncertainty regarding diagnosis and treatment. Current studies are aimed at specific disease targets such as delta-like ligand 3, etc.

Incorporating Artificial Intelligence (AI)

Q: Your original article doesn’t really address the integration of AI into the clinical PCa world as a way to improve diagnosis and treatment planning. It can quickly and accurately pick up PCa on MRI scans, and it’s been shown to analyze patient disease factors and genetic data for personalizing therapy. Do you see AI as a transformative tool?

A: AI, when properly incorporated, has indeed shown utility. It’s already being used to help predict the benefit of ADT in men with intermediate-risk PCa based on AI analysis of pathology slides. Globally, many uses of AI in the world of PCa are being developed and tested, and this is very promising. We thank you for your thoughtful questions, and we recognize your enthusiasm for ways to improve the lives and outcomes of patients.

So, readers, there you have it. Of course, when doctors attend conferences, this kind of peer dialogue happens live on stage as well as in informal encounters. I hope this example of how journals also keep professional discussions alive, since busy doctors can’t always fly off to meetings and assemblies. Reading journals is an important part of keeping up-to-date, both generally and in our areas of specialization. Journals assist in connecting readers with authors, enabling valuable networking.

I hope the particular dialogue summarized in this blog gives you reason to hope that all of us—doctors, researchers, scientists—are all working hard to improve the world of PCa.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Raychaudhuri R, Lin DW, Montgomery RB. Prostate Cancer: A Review. JAMA. 2025;333(16):1433–1446.
[ii] Miao Y, Zhao K, Shang A. Complexity of Prostate Cancer. JAMA. Published online July 09, 2025.
[iii] Raychaudhuri R, Lin DW, Montgomery RB. Complexity of Prostate Cancer—Reply. JAMA. Published online July 09, 2025.