Inside Issue #3
Radioligand therapy in advanced PCa - (01/15/26)
Incision-free, MRI guided prostate treatment - (01/15/26)
Immunotherapeutic strategies for PCa - (01/16/26)
The European Code Against Cancer, 5th Edition - (01/16/26)
Variation in PCa growth rate with active surveillance - (01/16/26)
Mini purple carrots vs. colon cancer cells - (01/19/26)
2026: The Most Important Papers 01/15 - 01/21
(1 minute read)
Exciting! This paper reviews one of the most promising advances in advanced prostate cancer treatment: radioligand therapy. In simple terms, this approach uses highly targeted radioactive “payloads” that lock onto PCa cells and deliver radiation directly where it’s needed, while largely sparing healthy tissue. The best-known example is lutetium-177 PSMA therapy (often called Pluvicto), which has already been shown in large clinical trials to extend survival and slow disease progression in men with advanced, treatment-resistant PCa.
What makes this field especially exciting is how fast it’s evolving. Newer versions use different types of radiation that may work even better on tiny clusters of cancer cells, and researchers are now testing combinations with hormone therapy, immunotherapy and DNA-repair drugs to make these treatments even more effective.
The big picture message: targeted radiation therapy is rapidly becoming a core pillar of advanced PCa care, no longer just a fringe option.
SHOULD YOU CONSIDER RADIOLIGAND THERAPY?
Ask about PSMA PET imaging. This scan helps determine whether radioligand therapy is even an option and plays a key role in guiding treatment decisions.
Understand that timing matters. Radioligand therapies are no longer reserved only as a last resort. Many studies now show benefit earlier in the disease course.
Explore combination strategies. If radioligand therapy is being considered, ask your doctor whether combining it with hormone therapy or other treatments could improve results.
Stay engaged and curious. This field is evolving rapidly, and options that weren’t available a year ago are available now or very soon.
(1 minute read)
[Ed. Note: This is not a scientific research paper. More of a “thought you should know.”]
Mount Sinai has become the first health system in the New York metro area to offer the TULSA-PRO® procedure, an incision-free, MRI-guided treatment for PCa and benign prostatic hyperplasia (BPH). This technology uses robotically controlled ultrasound delivered through the urethra to precisely heat and destroy targeted prostate tissue while continuously monitoring temperature in real time using MRI. The goal is to treat disease while protecting surrounding nerves and structures that affect urinary control and sexual function.
Early experience at Mount Sinai shows patients going home the same day, with no surgical incisions, no blood loss and a faster recovery compared with traditional surgery or radiation. The fact that a major academic medical center has adopted this technology signals growing confidence that precision, image-guided therapies may meaningfully change how prostate disease is treated.
THIS IS ANOTHER “SHOULD YOU CONSIDER THIS TREATMENT” MOMENT
Start the conversation with your care team. If you or someone you care about has localized PCA or significant BPH, ask whether MRI-guided focal therapies like TULSA-PRO may be appropriate.
Understand that selection matters. These treatments depend on disease stage, prostate size and overall health. They are not right for everyone.
Balance treatment and quality of life. For carefully selected patients, incision-free, MRI-guided therapies may offer cancer control while helping preserve continence and sexual function.
Choose centers with multiple options. Seek care at facilities that offer more than one treatment pathway rather than relying on a single “default” approach. This goes not just for PCa, but for any medical treatment.
(1 minute read)
This comprehensive 2026 review explains why immunotherapy has been far more challenging in PCa than in cancers like melanoma or lung cancer. PCa is considered an “immune-cold” tumor, meaning it doesn’t naturally attract or activate immune cells very well. As a result, common immunotherapies like checkpoint inhibitors (drugs that release immune “brakes”) work in only a small percentage of men.
The paper reviews the full landscape of immunotherapy approaches like cancer vaccines, checkpoint inhibitors, CAR T-cell therapies and combination treatments and makes one point quite clear: immunotherapy is unlikely to work as a standalone treatment for most PCa, but it may become effective when paired with hormone therapy, radiation, chemotherapy or targeted treatments that help “wake up” the immune system.
ALTHOUGH IMMUNOTHERAPY WORKS WELL WITH OTHER DISEASES, PCa REMAINS A CHALLENGE
The goal here is clarity. Immunotherapy for PCa is highly selective.
Ask about genetic testing. A small group of men may benefit from immunotherapy and tumor genetics help identify who those men are.
Ask better questions. Instead of “Does immunotherapy work?”, ask “Under what conditions might it work for me?”
Understand why combinations matter. Treatments that reduce tumor burden, alter the tumor environment or improve immune signaling may make immunotherapy more effective over time.
(1 minute read)
This paper summarizes the European Code Against Cancer, 5th Edition, which represents a massive, international consensus effort to identify lifestyle choices that meaningfully reduce cancer risk.
After reviewing decades of high-quality evidence, the authors conclude that several everyday behaviors consistently influence cancer risk across populations: eating a diet rich in whole grains, vegetables, legumes and fruits; limiting red meat and avoiding processed meat; maintaining a healthy body weight; being physically active; limiting prolonged sitting; and avoiding ultra-processed foods and sugar-sweetened beverages.
Excess body weight alone is now linked to increased risk of advanced PCa, among many other cancers. The strength of this paper lies in that it focuses on actions supported by the highest level of evidence available in cancer prevention science.
SHORT TERM FIXES ARE NOT THE ANSWER
Cancer prevention is built from boring, repeatable habits. Consistency matters far more than perfection or extremes.
Make plants the foundation of most meals. Cut back on processed and packaged foods whenever possible.
Move every day. Even walking counts, and it adds up over time.
Watch how long you sit. Break up long periods of inactivity, not just formal exercise sessions.
You already know ALL of this. Try to make small changes every day to save yourself from heartache later.
(1 minute read)
[Ed. Note: Yes, another paper on Active Surveillance. There were also many more scientific studies this week on ultra-processed foods and your gut microbiota. This stuff matters and is being studied to the Nth degree.]
This study followed men with low- to intermediate-risk PCa on MRI-based active surveillance to better understand how fast PCa actually grows. By carefully measuring tumor volume on repeated MRIs and modeling growth over time, the researchers found that prostate cancer generally grows very slowly, but with wide variation between individuals.
On average, a PCa lesion took about 17 years to grow from a single cell to a size that could be detected on MRI and another 10–12 years to become large enough to be clinically detectable. Even among visible tumors, many showed long periods of little or no growth. Faster growth was more likely in older men, those with higher PSA and those with Gleason 3+4 disease compared with Gleason 3+3 [I will explain Gleason scoring in the next Monday Brief]. The overarching message is that many PCa’s progress far more slowly than people assume, which helps explain why active surveillance is a safe and effective strategy for carefully selected men.
ACTIVE SURVEILLANCE IS HELPFUL EVEN IN ADVANCED CASES OF PCa
Let this research reduce fear, not increase it. Prostate cancer is often a slow-moving disease, and immediate treatment is not always necessary or beneficial.
Trust structured monitoring. Regular PSA testing and MRI can safely track changes over time without rushing into surgery or radiation.
Expect small or slow changes. Minimal year-to-year changes are often normal biology.
(1 minute read)
This study looked at something surprisingly powerful: how different types of carrots might directly interact with cancer cells. Researchers compared carrots of different colors and sizes and found that mini purple carrots stood out in a big way. They were packed with unique polyphenols (antioxidants), especially chlorogenic acid and specific anthocyanins, and showed the strongest ability to slow the growth of human colon cancer cells in the lab.
One of the most interesting findings was that these compounds are poorly absorbed in the upper digestive tract, which turns out to be a good thing. It means they reach the colon largely intact, where they can directly interact with colon cells. Even more striking, extracts from mini purple carrots caused cancer cells to stall in the cell cycle in a way similar to a common chemotherapy drug, suggesting real biological activity.
VITAMINS & SUPPLEMENTS ARE ALWAYS BETTER IF THEY COME FROM FOOD
Carrots are not a cancer treatment, but the food you eat makes a difference. Not all carrots are created equal and variety makes a real biological difference.
Color and size matter. Purple carrots, especially smaller ones, appear to deliver a different and potentially more protective mix of plant compounds than standard orange varieties.
Widen your plant palette. When you see purple carrots, rainbow carrots, or heirloom varieties, consider adding them to your routine.
This goes for more than just carrots. If given a choice, always choose the darker fruit or vegetable. There’s almost always more phytonutrients and antioxidants in the darker one.
OTHER NEWS
So I thought I could keep this newsletter at 5 scientific journal articles, but this is the second week we’ve gone over. There’s just too much to share with you, so this looks like the norm rather than the exception.
If you like the general direction this newsletter is going, please let me know. If you don’t, I would LOVE your suggestions on how to improve it and make it more user friendly.
Please share with others who may benefit from the work we’re doing 🙂
And, THANK YOU!!