New Delhi: Prostate cancer is a malignancy that originates in the prostate gland, a small walnut-shaped organ located below the bladder in men. It is among the most prevalent cancers affecting men globally and is increasingly recognized in India. Prostate cancer is the world’s second most common cancer among men. It accounts for approximately 14.2% of new cancer cases in men, with an age-adjusted incidence rate of 29.4 per 100,000 population. According to studies, the incidence of cases is 19,095, with a mortality rate of 12,231. The overall survival rate is 64%. Hence, it is important to look for better treatments to reduce the mortality rate for prostate cancer.

Dr Kunjahari Medhi, Senior Director, Medical Oncology, Cancer Care, Medanta, Gurugram, explained how immunotherapy could be the future of prostate cancer prevention.

Causes and Treatment Options

The precise origin of prostate cancer is still unknown, but there are some identified risk factors. Age contributes, as most instances are observed in men aged 50 or older. Family history and gene mutations also make a vital contribution. Lifestyle items, such as diet and exercise, may also impact risk levels.

Treatment strategies for prostate cancer are tailored based on the cancer’s stage, grade, and the patient’s overall health. Options include:

1. Active Surveillance: Regular monitoring of the cancer without having an immediate treatment, applicable for low-risk patients.
2. Surgery: Radical prostatectomy is the removal of the prostate gland.
3. Radiation Therapy: Using high-energy beams to kill cancer cells.
4. Hormone Therapy: Lowering androgen levels to minimise cancer growth.
5. Chemotherapy: A drug-based approach to destroy rapidly growing cancer cells.
6. Targeted therapy: using the molecular targets, such as genetic mutation (such as PARP inhibitors in BRCA-positive cases)
7. Immunotherapy: Through the activation of immune cells to destroy the cancer cells.
8. Radioligand therapy: Lutetium 177 psma therapy

Despite these treatments, advanced or metastatic prostate cancer remains challenging to manage. This has led to the exploration of immunotherapy as a promising avenue.

Immunotherapy: A New Frontier in Prostate Cancer Treatment

Immunotherapy is a paradigm shift in cancer treatment because it uses the immune system of the body to fight against cancer cells. Immunotherapy is when your immune system is activated to detect and kill cancer cells better. Some immunotherapies may be used to treat prostate cancer. The treatment is only possible in some centres, and you need to consult your doctor to know whether it is suitable for your case or not. Currently, various immunotherapeutic methods are under exploration:

1. Sipuleucel-T (Provenge): A vaccine approved by the FDA that elicits an immune response against prostate cancer cells with prostatic acid phosphatase (PAP) expression.
2. Checkpoint Inhibitors: Medications such as pembrolizumab (Keytruda) inhibit proteins that keep immune cells from killing cancer cells, with evidence of activity in tumors with certain biomarkers (PDL1 positive, MSI high, etc) positivity.
3. Viral Vector Vaccines: Manipulated viruses, like Prostvac-VF, introduce prostate-specific antigens to stimulate an immune response.
4. Oncolytic Viruses: Genetically engineered viruses that target and destroy cancer cells while activating an immune response.

These treatments tend to be administered alongside conventional therapies to maximize efficacy.

Conclusion

Prostate cancer is an important health problem in India, with increasing incidence and an alarming trend among young males. Though conventional treatment modalities are still the cornerstone, the emergence of immunotherapy gives new promise, especially in advanced disease. Further research provides useful information for cancer prevention and control activities through intervention of early detection, reduction in risk, and prostate cancer management.