Study Finds 25% of Advanced Prostate Cancers Progress Without PSA Rise
Updated
Updated · Cornell Chronicle · Jul 1
Study Finds 25% of Advanced Prostate Cancers Progress Without PSA Rise
3 articles · Updated · Cornell Chronicle · Jul 1
Summary
More than 2,500 men in two phase 3 enzalutamide trials showed that up to roughly 25% of advanced prostate cancer patients had tumor growth on imaging despite stable—or even undetectable—PSA levels.
Those patients had worse overall survival, and many reported no new symptoms, suggesting routine PSA blood tests alone can miss clinically meaningful progression during treatment.
ARCHES and PROSPER produced similar findings across metastatic hormone-sensitive and non-metastatic castration-resistant disease, pointing to a broader monitoring gap in advanced prostate cancer.
Researchers said tumors may evolve to grow with little androgen-receptor signaling and produce little PSA, and they urged periodic imaging—especially in the first two years of therapy—and possible guideline changes.
Your PSA is stable, but could your prostate cancer still be growing?
Can we reprogram drug-resistant cancer cells to make old therapies effective again?
Beyond PSA: The Urgent Need for New Metrics in Prostate Cancer Monitoring and Screening
Overview
Recent research in 2026 has revealed that prostate cancer can progress even when PSA levels are low or undetectable, challenging the long-standing reliance on PSA as the main biomarker for monitoring the disease. This disconnect between PSA levels and actual cancer progression means that current monitoring strategies may miss aggressive cancers. The underlying reason is that some prostate tumors develop resistance, allowing them to grow without depending on androgen receptor signaling, which is usually linked to PSA production. As a result, there is an urgent need to re-evaluate diagnostic approaches and develop new ways to accurately track prostate cancer.