Prostate cancer is the most common cancer among men in Israel and throughout the Western world. Yet many men still do not know when they should begin screening, who is at increased risk, or how dramatically the diagnostic process has changed in recent years.
According to Prof. David Margel, director of innovation, research and risk management at Assuta Hospital in Ramat HaHayal, one of the most common misconceptions is that prostate cancer always causes symptoms.
"In reality, in most cases the disease develops completely silently. Many men feel perfectly well and therefore do not seek medical evaluation. Precisely because prostate cancer is usually asymptomatic in its early stages, screening plays a crucial role."
According to Prof. Margel, most men should begin routine screening around the age of 50. However, men with a first-degree relative diagnosed with prostate cancer, or those known to carry certain genetic mutations such as BRCA, may need to begin screening earlier, based on their physician's recommendation.
"Family history is extremely important information, which is why patients should inform their doctor as early as possible."
Even when urinary symptoms do appear, they do not necessarily indicate prostate cancer. Frequent nighttime urination, a weak urine stream, urgency, or difficulty emptying the bladder may also result from benign enlargement of the prostate, a common condition in older men.
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Nevertheless, Prof. Margel emphasizes that such symptoms should never be ignored. "Any significant change in urinary habits warrants medical evaluation. Even if cancer is ultimately ruled out, it is important to identify the underlying cause."
One of the most common questions is whether a PSA blood test alone is sufficient to diagnose or rule out prostate cancer. According to Prof. Margel, the answer is more complex.
The PSA test is an important screening tool, but it cannot diagnose prostate cancer on its own. Elevated PSA levels may also result from non-cancerous conditions. As a result, additional diagnostic tests are now routinely used before deciding on further evaluation.
"Over the past few years, there has been a significant shift in the way we diagnose prostate cancer. In the past, many patients with elevated PSA levels were referred almost automatically for biopsy. Today, in most cases, patients first undergo a prostate MRI. Only if the MRI identifies a suspicious lesion do we decide whether a biopsy is necessary."
The prostate
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According to Prof. Margel, combining PSA testing with MRI enables physicians to identify more accurately which patients truly require a biopsy while avoiding unnecessary procedures in others.
The biopsy procedure itself has also changed significantly in recent years. While biopsies were traditionally performed through the rectum, current professional guidelines increasingly recommend the transperineal approach, performed through the skin, which carries a lower risk of infection.
At the same time, robotic systems such as the Liza Mona Biobot have entered clinical practice. These systems combine MRI images with real-time ultrasound guidance, allowing physicians to target suspicious areas with greater precision.
The technology enables more accurate tissue sampling, reduces the number of needle insertions, and lowers the risk of infection compared with conventional biopsy techniques.
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According to Prof. Margel, these advances are not merely technological. "When we can accurately target the suspicious area during the first biopsy, we reduce the need for repeat procedures and shorten the time to diagnosis. Ultimately, our goal is not only to detect the disease, but to do so as accurately and safely as possible for each patient."
Treatment options have also advanced considerably. When prostate cancer is detected at an early stage, physicians can tailor treatment to each patient's individual condition. In some cases, particularly when the tumor is considered low risk, active surveillance may be the most appropriate approach. In other cases, advanced surgical, radiation, and systemic therapies are available, with treatment decisions based on the characteristics of the disease and the patient's overall health.
"The most important message is not to wait until pain develops," concludes Prof. Margel. "In many cases, prostate cancer causes no symptoms until more advanced stages. Timely screening, together with improvements in MRI imaging and biopsy technologies, now allows us to diagnose the disease earlier, select more precise treatments, and in many cases preserve patients' quality of life."