[Immunotherapy for metastatic prostate cancer: do we really need this?]

Following the approval of Sipuleucel-T, the development of new immunomodulatory approaches such as ipilimumab and tasquinimod, and the development of new antihormonal drugs (abiraterone acetate, MDV3100, TAK-700), treatment of castration-resistant prostate cancer is finally reaching a new era of management. Docetaxel based chemotherapy remains the standard treatment of choice for patients with a high tumour burden, rapidly progressiong castration resistant prostate cancer, and poorly differentiated prostate cancer. Sipuleucel-T might be an option in the pre-docetaxel management of castration-resistant prostate cancer resulting in a 4-months improvement of overall survival. However, as with all other modalities of immunotherapy patients with good prognostic factors such as minimal tumour burden, slow PSA doubling time, Gleason score ≤ 7, and a long survival probability of > 1 year might be the best candidates taking into account that immunomodulatory approaches demonstrate positive responses after 4-6 months of therapy. Ipilimumab and tasqunimod as inhibitors of the immune checkpoints are additional, promising therapeutic agents with high clinical potential. It is the aim of the current article to critically review the current options of immune therapy in men with castration resistant prostate cancer.