In United States, prostate cancer is the most common cancer diagnosis (excluding dermatological malignancies) and the second leading cause of cancer related mortality in men . Early stage prostate cancer has an indolent course; however local tumor progression and aggressive metastatic disease may develop in the long term . Androgen deprivation therapy provides disease control for a substantial period of time; however the vast majority eventually progress [3, 4]. In hormone refractory cases, chemotherapy with docetaxel and prednisone led to a superior survival and quality of life . This combination remained as the predominant first line of chemotherapeutic option for a significant period of time. Only recently have new advances in chemotherapeutic, anti-androgen and other novel therapeutic options made it into the clinic.
Sipuleucel-T in patients with castration-resistant metastatic prostate cancer demonstrated a reduction in the risk of death . The sipuleucel-T trial results have helped demonstrate a proof of concept of the potential of immunotherapy in prostate cancer but widespread acceptance of its use has been tempered by the time limited survival advantage of only four months. Therefore, we continue to need novel agents and combination strategies which build on this initial success. Several other inter-related patho-physiological mechanisms like inflammation and genetic/epigenetic modulation are under investigation in prostate cancer which could have further implications in the development of these new immunotherapeutic preventive and treatment strategies [7, 8].
In this article we will give an overview about the role and link of inflammation, epigenetic modulation and immune modulation in the development and treatment of prostate cancer. It is imperative that new approaches that further define immune responsiveness and identify which patients are most likely to benefit. With the increasing availability of novel agents, future advances will also lie in innovative combination strategies.