Israel: Detecting aggressive forms of prostate cancer before surgery

Soroka Medical Center. @Soroka Spokesperson

A team from Clalit Health Services at Soroka Medical Center in Beersheba is shedding new light on the management of prostate cancer, the most common cancer among men. Published in the journal JU Open Plus, the study suggests it may be possible to more accurately identify aggressive forms of the disease even before surgery, using simple biopsy-derived criteria.

Leading the research, Nicola Mabjeesh, Head of the Department of Urology, highlights a major limitation in current diagnostic tools. “Some patients appear to be at low risk based on PSA levels, tumor grade, or MRI findings, when in reality their cancer is more advanced,” he explains.

Prostate cancer develops in a small gland located beneath the bladder. In many cases, it progresses slowly and can remain asymptomatic for years. However, certain forms are more aggressive and can spread beyond the prostate, making it crucial to distinguish between patients who can be safely monitored and those who require prompt treatment.

Professor Nicola Mabjeesh, Head of the Urology Department at Clalit-Soroka Medical Center and Principal Investigator. @Clalit-Soroka Medical Center

The study analyzed 131 patients who underwent surgery between 2020 and 2024. Researchers aimed to go beyond traditional indicators by focusing on two concrete parameters derived from fusion biopsy (combining MRI and ultrasound): the number of cancerous sites detected and the length of the largest lesion.

The rationale is straightforward: the greater the number of cancerous foci and the larger the primary lesion, the higher the likelihood that the disease is already advanced.

The findings are significant. Following surgery, approximately 41% of patients were found to have more advanced disease than initially predicted, including extension beyond the prostate, involvement of the seminal vesicles, or positive surgical margins.

Notably, conventional indicators failed to reliably predict these advanced cases. In contrast, the two newly studied criteria showed a strong correlation with the actual aggressiveness of the disease.

“Today, clinical decisions rely heavily on tumor grade. For example, a Grade 1 classification often leads to active surveillance. We propose adding another layer of analysis: if more than three cancerous areas are identified, surgery should be considered,” adds Prof. Mabjeesh.

These findings could also help guide the choice between surgery and radiotherapy by revealing previously underestimated tumor spread.

One of the study’s key contributions is the identification of patients classified as “low risk” under standard criteria who in fact had more extensive disease.

According to the researchers, integrating these new indicators could refine the selection of patients eligible for active surveillance and help avoid inappropriate treatment strategies. The analysis also suggests a potential—albeit moderate—reduction in overtreatment.

“The next step is to validate these criteria in larger cohorts so they can be incorporated into clinical practice,” says Prof. Mabjeesh, who believes these parameters could eventually be included in international guidelines.

Caroline Haïat