Prostate Cancer Treatment in Israel

Prostate cancer is the second most common malignant tumor in men worldwide and one of the main reasons patients from the CIS come to Israel for treatment. At the Sourasky (Ichilov) Medical Center in Tel Aviv, issues of urological oncology are handled by a multidisciplinary team formed over decades: urologic surgeons, radiation therapists, medical oncologists, nuclear medicine specialists, and pathologists. This structure allows for a unified patient pathway — from the first elevated PSA value and multiparametric MRI to robot-assisted surgery, brachytherapy, Lu-177 PSMA radioligand therapy, or targeted PARP inhibitors. In this article, we will detail how Ichilov diagnoses and treats prostate cancer in 2026, what protocols are used at each stage of the disease, how long the program takes, what results to expect, and what approximate prices to budget for a trip to Tel Aviv.

What is this disease

Prostate cancer is a malignant tumor that develops from the glandular epithelium of the prostate. According to international registries, more than 1.4 million new cases are registered worldwide each year; in the age group of 65+, it is one of the leading oncological pathologies. The biology of the disease is extremely heterogeneous: some tumors are indolent, remaining confined within the capsule for years and not affecting life expectancy, while others behave aggressively from the outset, rapidly metastasizing to bones, lymph nodes, lungs, and liver. This is why the modern approach at the Sourasky clinic is based not on a "one-size-fits-all" protocol, but on precise risk stratification.

Key risk factors include age (incidence sharply increases after 55–60 years), hereditary predisposition (BRCA1/2, HOXB13, ATM mutations, HRR repair system genes), family history of prostate, breast, or ovarian cancer in close relatives. A separate proven factor is ethnicity: men of African descent have approximately 1.6 times higher incidence, and the disease often begins at a younger age. Additionally, obesity, metabolic syndrome, chronic prostatitis, and diets high in animal fats are discussed. An intermediate stage is high-grade prostatic intraepithelial neoplasia (HGPIN), which, with regular monitoring and the right tactics, does not always progress to invasive cancer.

Clinically, the disease often remains asymptomatic for a long time: a small tumor, even one capable of producing micrometastases, may not manifest at all. As the gland grows, symptoms emerge that are largely similar to benign prostatic hyperplasia — frequent and difficult urination, weakened stream, nighttime urges (nocturia), the sensation of incomplete bladder emptying, traces of blood in urine or semen, erectile dysfunction. Pain in the pelvic bones, spine, ribs, pathological fractures, unexplained anemia, and weight loss often become the first signs of the metastatic stage. Therefore, a key role at Ichilov is assigned to PSA screening in men aged 45–50 and earlier in cases of significant hereditary burden.

Diagnosis at Ichilov Clinic

The complete diagnostic protocol at the Sourasky clinic typically takes 3–7 working days and includes laboratory tests, imaging, histology, and, if indicated, genomic testing. The goal is not just to confirm cancer but to accurately determine its aggressiveness and stage to choose the optimal treatment protocol.

• PSA test (total, free, ratio, and derived indicators). Prostate-specific antigen is the basic tumor marker. At Ichilov, not only the absolute value is assessed, but also the dynamics (PSA velocity, PSA doubling time), density (PSA density), and the ratio of free/total PSA. This reduces the number of false-positive results and unnecessary biopsies in men with benign hyperplasia.
• Multiparametric MRI 3 Tesla (multiparametric MRI). Allows visualization of suspicious tissue lesions, assesses them according to the PI-RADS v2.1 scale, and detects extracapsular invasion, involvement of seminal vesicles, and regional lymph nodes. Sensitivity for clinically significant cancer is up to 90%+.
• Fusion biopsy under MRI/ultrasound guidance. Targeted sampling from suspicious areas identified on MRI, instead of "blind" random transrectal biopsy. The accuracy of detecting clinically significant cancer increases by 30–40%, while the risk of underdiagnosing aggressive tumors decreases.
• Histology, Gleason score, and ISUP grade group. The pathologist evaluates the tumor architecture, sums the Gleason scores, and assigns an ISUP grade group from 1 to 5. This is a basic prognostic marker that determines the tactics: active surveillance, radical treatment, or immediate systemic therapy.
• Staging according to TNM. Based on clinical data, MRI, PET-CT, and biopsy results, the stage is assigned: localized cancer (T1–T2), locally advanced (T3–T4), with regional lymph node involvement (N+), or distant metastases (M1).
• PSMA-PET/CT (68Ga-PSMA or 18F-PSMA). The modern "gold standard" for staging and detecting biochemical recurrence. This method detects micrometastases as small as 2–3 mm, which are not visible on conventional CT, MRI, and bone scintigraphy. At the Sourasky clinic, PSMA-PET is used both before primary treatment in patients at intermediate and high risk and when recurrence is suspected.
• Tumor genomic testing (Prolaris, Decipher). Prognostic panels that assess cancer aggressiveness based on gene expression from biopsy or prostatectomy tissue. They help determine whether active surveillance is sufficient, if adjuvant radiation therapy is needed, or if an expanded treatment volume is required.
• Patient genetic testing. BRCA1/2, ATM, CHEK2, PALB2 panel, MMR system genes — determines the hereditary nature of the disease and opens access to targeted therapy with PARP inhibitors (olaparib, rucaparib), and is also important for relatives.
• Additional studies. Uroflowmetry, residual urine volume, TRUS, chest/abdominal CT, bone scintigraphy — as indicated.

Based on the examination results, the patient's data is discussed at a multidisciplinary tumor board, where a personalized treatment plan is developed.

Methods of Treating Prostate Cancer at Ichilov

The tactics at the Sourasky clinic are based on international guidelines from EAU, NCCN, ESMO and are adapted to the specific situation: TNM stage, Gleason score/ISUP, PSA level and dynamics, age, comorbidities, and the patient's own priorities. Below are the main modalities available at Ichilov.

Active Surveillance

For patients with localized very low and low-risk cancer (ISUP 1, PSA < 10 ng/ml, T1c–T2a, limited tumor volume), an active surveillance program is applied: PSA every 3–6 months, mpMRI every 12 months, repeat targeted biopsy as indicated. This approach is often supplemented with genomic testing (Prolaris or Decipher) and allows some patients to postpone or completely avoid invasive treatment while preserving urinary retention function and potency.

Robot-Assisted Radical Prostatectomy (RARP, da Vinci)

The main surgical method for localized and locally advanced cancer. The operation is performed through 5–6 small incisions, and the da Vinci robotic system provides three-dimensional HD imaging with 10x magnification and micron precision of instruments. This allows for nerve-sparing techniques while preserving the neurovascular bundles responsible for erection and urinary retention. Blood loss is usually minimal, hospitalization lasts 2–3 days, and return to active life occurs within 3–4 weeks. In cases of intermediate and high risk, an extended pelvic lymphadenectomy is performed simultaneously.

IMRT and VMAT — Modulated Radiation Therapy

External beam radiation therapy with intensity modulation (Intensity-Modulated Radiotherapy) and its variant with arc rotation (VMAT). The course consists of 20–39 sessions, with the dose precisely targeted to the prostate while sparing the rectum, bladder, and femoral heads. IMRT/VMAT is the workhorse of prostate radiation therapy, used both as a standalone radical method and as adjuvant or salvage therapy after surgery.

SBRT — Stereotactic Radiation Therapy

A hypofractionated variant of radiation therapy — 5 sessions of high-dose precise therapy on TrueBeam machines or CyberKnife systems. Suitable for some patients with localized cancer, it reduces the overall treatment time from 8 weeks to 1–2 weeks and shows comparable oncological results to classical IMRT according to several studies.

Brachytherapy LDR and HDR

Interstitial radiation therapy: low-dose (LDR — permanent implantation of I-125 or Pd-103 seeds) or high-dose (HDR — temporary placement of Ir-192 sources through catheters). LDR brachytherapy is suitable for localized low-risk cancer and some cases of intermediate risk; HDR is often used in combination with external beam radiation therapy for intermediate and high risk. Local tumor control is achieved with minimal impact on surrounding tissues; historically, the Sourasky clinic in Tel Aviv was at the forefront of implementing prostate brachytherapy in Israel.

Proton Therapy

When indicated — for example, in younger patients where it is important to reduce the integral radiation load and risk of secondary tumors — Ichilov patients are referred to specialized proton centers. Due to the physics of the Bragg peak, protons deliver the main dose directly to the tumors, leaving surrounding tissues almost unharmed.

Hormonal Therapy (ADT and New Generation Antiandrogens)

Androgen deprivation therapy is the basis of systemic treatment for locally advanced, metastatic, and biochemically recurrent cancer. LHRH analogs (leuprolide, goserelin) and LHRH antagonists (degarelix, relugolix) are used, and bilateral orchiectomy is performed when indicated. New generation antiandrogens are added to ADT: enzalutamide, apalutamide, darolutamide, as well as the androgen biosynthesis inhibitor abiraterone in combination with prednisone. This combination ("ADT + new hormonal agents") is now standard for hormone-sensitive metastatic cancer and significantly improves survival compared to ADT monotherapy.

Chemotherapy

Cytostatics docetaxel and cabazitaxel are prescribed for metastatic hormone-sensitive cancer (in combination with ADT, protocols CHAARTED, STAMPEDE) and for castration-resistant forms of the disease. The regimen and number of cycles are tailored to the patient's tolerance, functional status, and the condition of the bone marrow and liver.

Targeted Therapy with PARP Inhibitors

For patients with germline or somatic mutations in BRCA1/2, ATM, and other homologous recombination repair (HRR) genes, PARP inhibitors — olaparib (Lynparza) and rucaparib — are used at the Sourasky clinic. These drugs prolong progression-free survival in metastatic castration-resistant prostate cancer (mCRPC), especially in BRCA-positive patients.

Radioligand Therapy 177Lu-PSMA

One of the key achievements in recent years is radioligand therapy 177Lu-PSMA-617 (Pluvicto). The radioactive isotope binds to a molecule that specifically recognizes the PSMA protein on the surface of prostate cancer cells and destroys them from within. This method is used for metastatic castration-resistant cancer after standard lines of therapy have been exhausted; the selection criterion is "hot" spots on diagnostic PSMA-PET.

Immunotherapy

Checkpoint inhibitors (pembrolizumab) are used in prostate cancer in a limited manner — primarily in tumors with high microsatellite instability (MSI-H) or MMR deficiency (dMMR). This molecular subtyping is another reason why genomic and molecular testing is routinely performed at Ichilov.

Treatment Program — Stages

Patients from the CIS typically go through several clear stages:

1. Application and preliminary assessment. The medical coordinator of the international department at Sourasky collects medical records, PSA, MRI, slides, and biopsy blocks, formulates a preliminary conclusion, and sends a diagnostic estimate.
2. Arrival in Tel Aviv, meeting at Ben Gurion Airport. Transfer to a hotel or apartment near the Ichilov clinic.
3. Diagnostic block (3–7 working days). Consultation with a urologic oncologist, laboratory tests, mpMRI 3 Tesla, fusion biopsy if necessary, PSMA-PET/CT, histological review of slides in the Sourasky laboratory, consultations with related specialists.
4. Multidisciplinary tumor board. Collegial discussion of the case, selection of the optimal protocol: active surveillance, RARP, radiation therapy, combination, systemic therapy. The patient receives a written conclusion and treatment plan.
5. Main treatment stage. Depending on the plan: hospitalization and robot-assisted prostatectomy, course of radiation therapy or brachytherapy, initiation of ADT, course of chemotherapy, PARP inhibitors, or radioligand therapy.
6. Early rehabilitation. Restoration of urinary retention (pelvic floor muscle training, if necessary — a urological rehabilitation specialist), support for erectile function (PDE-5 inhibitors, vacuum therapy), monitoring of side effects from radiation therapy and hormonal medications.
7. Follow-up. Monitoring program: PSA every 3 months for the first 2 years, then every 6 months, imaging as indicated. If PSA rises — expanded examination (PSMA-PET) and timely therapy adjustment. Remote follow-up via telemedicine with a coordinator in Tel Aviv is possible.

Prices and Costs

The cost of prostate cancer treatment at the Sourasky (Ichilov) clinic in Tel Aviv is individual and depends on the stage, volume of diagnostics, and chosen protocol. Approximate price ranges in US dollars are provided for budget planning. A precise estimate is formed after the initial consultation and receipt of examination results.

• Extended consultation with a urologic oncologist — from 550 USD
• Comprehensive diagnostics (PSA, mpMRI 3T, fusion biopsy, histology) — 5,500–8,500 USD
• PSMA-PET/CT — 2,200–2,800 USD
• Genomic panel Prolaris or Decipher — 2,200–3,500 USD
• Genetic panel BRCA/HRR — 1,800–2,500 USD
• Robot-assisted prostatectomy da Vinci "turnkey" — 27,000–34,000 USD
• Course of external beam radiation therapy IMRT/VMAT — 18,000–25,000 USD
• SBRT (5 sessions) — 20,000–26,000 USD
• LDR brachytherapy — 22,000–28,000 USD
• HDR brachytherapy (in combination) — 18,000–24,000 USD
• Course of hormonal therapy ADT (3 months) — from 2,800 USD
• Course of chemotherapy (1 cycle of docetaxel) — from 3,000 USD
• PARP inhibitors (olaparib, one month of therapy) — at current pharmacy prices
• Radioligand therapy 177Lu-PSMA (1 cycle) — 18,000–22,000 USD

The estimate usually includes anesthesia, hospitalization, operating room team work, consumables, and monitoring in the early postoperative period. Accommodation, meals outside the clinic, translator services, and transfers are paid separately.

Leading Doctors in the Field

Professor Chaim Matzkin — one of Israel's leading specialists in oncourology, an expert in the application of brachytherapy and hormonal therapy for prostate cancer. He has been involved in the development and implementation of modern treatment methods for many years; he pays special attention to early diagnosis, where early detection directly affects prognosis.

Professor Jack Baniel — head of the surgical urology department at the Sourasky Medical Center, deputy director of the oncology center. A surgical oncologist and urologist of the highest category, he specializes in surgeries for oncological diseases of the urogenital system, including radical prostatectomy and interventions for locally advanced tumors. He trained at Tel Aviv University and furthered his education at universities in the USA.

Dr. Leon Agulyansky — a urological surgeon with many years of practical experience, author of the scientific work "Prostate and Its Diseases" (published in Russian and Hebrew). He specializes in treating diseases of the prostate and bladder, including prostate resection, minimally invasive, and transurethral interventions. He is one of the most "Russian-speaking-friendly" specialists at the clinic — patients from the CIS can speak with him in their native language without a translator.

Dr. Avi Berry — senior specialist in the urology department at Sourasky, urologist of the highest category. He performs surgeries on the urogenital system and laparoscopic interventions on the kidneys, ureters, adrenal glands, bladder, and prostate. He received his education at the Tbilisi Medical Academy, studied urosurgery in depth at Tel Aviv University, and interned in Austria.

FAQ

What language is used for communication at the Ichilov clinic?

The main languages are Hebrew and English. For patients from the CIS, the Sourasky clinic provides a Russian-speaking medical coordinator who accompanies consultations, explains the protocol, and translates documents. Some doctors, including Dr. Leon Agulyansky, speak Russian.

What documents should be brought?

Records from previous examinations, all PSA tests with dates, ultrasound and MRI results on disks, slides and paraffin blocks of biopsy for review by the pathologist, fresh blood tests, and if available, genetic and molecular conclusions. It is advisable to scan all documents and send them to the coordinator in advance.

How long do diagnosis and treatment take?

The full diagnostic protocol takes 3–7 working days. Robot-assisted prostatectomy involves hospitalization for 2–3 days, with recovery to normal activity taking 3–4 weeks. The IMRT radiation therapy course lasts 4–8 weeks, SBRT takes 1–2 weeks, and brachytherapy involves a short hospitalization. Systemic therapy and ADT can begin in Israel and continue at home.

What advance payment is required?

The standard practice is to prepay for the diagnostic block upon arrival at the clinic. Payment for surgical or radiation treatment is made after agreeing on the final estimate, usually before hospitalization. The clinic accepts bank transfers and cards; the specific scheme is coordinated with the coordinator.

Is there a tumor board and can a second opinion be obtained?

Yes. All non-trivial cases of prostate cancer at Sourasky are discussed at a multidisciplinary tumor board — involving a urologic oncologist, radiation therapist, medical oncologist, pathologist, and radiologist. A second opinion on biopsy slides and MRI can be obtained remotely before arriving in Tel Aviv.

Does insurance cover treatment in Israel?

Policies from the "country of origin" usually do not cover treatment in Israel directly. Some international insurance policies and corporate programs include Ichilov as an accredited clinic — this is clarified individually. Upon request, the clinic prepares a complete package of bills and medical documents for subsequent reimbursement.

How is follow-up organized after returning home?

After completing the active phase of treatment, the patient receives a detailed monitoring plan: PSA schedule, indications for MRI and PSMA-PET, criteria for recurrence. Some follow-up consultations are conducted online with the treating physician at Sourasky; if PSA rises, a repeat visit to Tel Aviv for expanded examination is possible.

Is treatment possible at stage 4 with metastases?

Yes. Modern protocols (ADT in combination with abiraterone or enzalutamide, docetaxel, PARP inhibitors for BRCA+, radioligand therapy 177Lu-PSMA) significantly prolong life and maintain its quality even in generalized processes. Many patients live for years with controlled metastatic cancer.

How to Obtain a Treatment Program

To receive a personalized program for the diagnosis and treatment of prostate cancer at the Sourasky (Ichilov, Tel Aviv) Medical Center, submit a request through the form on the website or contact the clinic's international department. Attach the latest medical records, PSA values over time, MRI disks, histological slides and biopsy blocks, as well as, if available, results of genetic and genomic testing. The medical coordinator will organize a consultation with a urologic oncologist — in person in Tel Aviv or online, prepare an estimate and hospitalization schedule, assist with visa support, transfer from Ben Gurion Airport, and accommodation selection near the clinic. All documents are translated into Hebrew and English, and treatment conclusions are provided in English and Russian for further monitoring at the place of residence.