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Locally advanced prostate cancer (LAPC) or prostate cancer with biochemical recurrence (BCR) and “at high risk” of clinical relapse, together with current recommendations, is first examined. Then, conventional and investigational immunotherapies (ITs), including a new IT schedule aimed at inhibiting cancer immune suppression, are described. The Cancer of the Prostate Risk Assessment (CAPRA) score (more than 33% of biopsy cores positive, along with age, clinical T stage, prostate-specific antigen (PSA), and Gleason score) and the nomograms by Kattan (a multivariable model combining clinical T stage, Gleason score, and PSA) are commonly used to estimate the risk of treatment failure after radical prostatectomy (RP). However, in both instances, 5-year relapse-free survival varied from 49% to 80% for the same population. Therefore, the best management of “high-risk” prostate cancer disease is an evolving area to further refine the risk and guide therapy selection. RP or definitive radiation therapy (RT), neoadjuvant or adjuvant androgen deprivation therapy (ADT), and adjuvant RT in LAPC are more often carried out. Any measurable or not measurable PSA suggests the presence or absence of minimal residual disease (MRD), respectively, and BCR is a dynamic parameter likely indicating “progressing” MRD. Patients with a shorter PSA-DT ≤ 1 year, a pGS of 8–10 for RP, an IBF ≤ 18 months, or a bGS of 8–10 for RT are classified as having a European Association of Urology (EAU) high-risk BCR. Sipuleucel-T is the only IT approved by the FDA for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancers, and all other ITs are investigational. Among them, a new schedule-inhibiting cancer immune suppression can avoid or significantly delay MRD progression with a concomitant improvement in quality of life. Risk assessment and therapy for LAPC or prostate cancer with BCR and “at high risk” of clinical relapse are continuously refined. In this relevant subset, promising preliminary findings with a new IT schedule are shown.

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Minimal Residual Disease (MRD) and a New Immunotherapy in Locally Advanced Prostate Cancer

  • 章节

  • 发表日期：

    2022年

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  • Andrea Nicolini,
  • Paola Ferrari

摘要

Locally advanced prostate cancer (LAPC) or prostate cancer with biochemical recurrence (BCR) and “at high risk” of clinical relapse, together with current recommendations, is first examined. Then, conventional and investigational immunotherapies (ITs), including a new IT schedule aimed at inhibiting cancer immune suppression, are described. The Cancer of the Prostate Risk Assessment (CAPRA) score (more than 33% of biopsy cores positive, along with age, clinical T stage, prostate-specific antigen (PSA), and Gleason score) and the nomograms by Kattan (a multivariable model combining clinical T stage, Gleason score, and PSA) are commonly used to estimate the risk of treatment failure after radical prostatectomy (RP). However, in both instances, 5-year relapse-free survival varied from 49% to 80% for the same population. Therefore, the best management of “high-risk” prostate cancer disease is an evolving area to further refine the risk and guide therapy selection. RP or definitive radiation therapy (RT), neoadjuvant or adjuvant androgen deprivation therapy (ADT), and adjuvant RT in LAPC are more often carried out. Any measurable or not measurable PSA suggests the presence or absence of minimal residual disease (MRD), respectively, and BCR is a dynamic parameter likely indicating “progressing” MRD. Patients with a shorter PSA-DT ≤ 1 year, a pGS of 8–10 for RP, an IBF ≤ 18 months, or a bGS of 8–10 for RT are classified as having a European Association of Urology (EAU) high-risk BCR. Sipuleucel-T is the only IT approved by the FDA for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancers, and all other ITs are investigational. Among them, a new schedule-inhibiting cancer immune suppression can avoid or significantly delay MRD progression with a concomitant improvement in quality of life. Risk assessment and therapy for LAPC or prostate cancer with BCR and “at high risk” of clinical relapse are continuously refined. In this relevant subset, promising preliminary findings with a new IT schedule are shown.