Harvard Men's Health Watch

Immunotherapy: A new option for advanced prostate cancer

A diagnosis of cancer is always frightening. Once the shock wears off, patients have to decide what to do next. And for most of the estimated 192,000 American men who will be diagnosed with prostate cancer this year, the decisions can be nearly as overwhelming as the diagnosis itself. Because scientific studies have not established which treatments are best, patients with early prostate cancer are asked to choose between deferred treatment (watchful waiting or active surveillance); surgery (conventional, laparoscopic, or robot-assisted); and radiation (external beam, proton beam, or brachytherapy with implanted radioactive seeds, with or without hormone therapy). To make matters even more confusing, some men also consider less established, experimental treatments, ranging from cryotherapy and high-frequency ultrasound to microwave or radiofrequency tumor ablation and lifestyle treatment using diet and supplements.

Most men respond well to these therapies, but some are confronted with recurrent prostate cancer, often years after the original treatment. These men face a simpler, if less attractive, situation since the next line of defense involves androgen-deprivation therapy. Although the timing and techniques of androgen deprivation also involve choices, the goal of all methods is to drastically reduce levels of testosterone, the male hormone that fuels the growth of prostate cancer.

Most prostate cancers respond well to androgen-deprivation therapy; prostate specific antigen (PSA) levels plummet, tumors shrink, and symptoms of the disease improve. The response is often dramatic, and it can last for years. Unfortunately, though, virtually all prostate cancers eventually escape from androgen-deprivation therapy and begin growing again. About 27,000 Americans will die from prostate cancer this year, and in nearly all, the culprit is an androgen-independent cancer. And that's where the new treatment comes in.

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