New approaches to the management of prostate cancer are being developed and tested in the Southern Baden Prostate Centre in Freiburg. Opened in 2007, the center provides optimal care and treatment to patients with prostate cancer, and is developing a new approach involving vaccination with dendritic cells. This technique was conceived by Dr Marc Azémar and Dr Bernd Hildenbrand, and pilot studies have already been completed at the center.
Hormone Refractory Prostate Carcinoma
Hormone refractory prostate carcinoma is an advanced stage of prostate cancer in which the patient no longer responds to hormone therapy. It can occur just a few months after hormone therapy begins, or may not develop for years. Hormone therapy works by inhibiting the action of testosterone, which promotes growth of the tumor cells. Anti-androgens may be used to block testosterone receptors, or testosterone production may be blocked by surgical or chemical castration. This therapy is usually effective in the early stages of prostate cancer, but in more advanced stages other therapeutic approaches are required.
Current Treatments for Hormone Refractory Prostate Carcinoma
Hormone refractory prostate carcinoma is difficult to treat. In some cases, ceasing anti-androgen treatment and reintroducing testosterone can shock the tumor and stop it from growing, but for most patients with hormone refractory prostate cancer, the chemotherapy drug taxotere is used in an attempt to halt tumor growth and prevent the cancer from spreading to the lymph nodes and bones. Taxotere has a number of unpleasant side effects, so alternative therapies would be welcomed by patients and doctors alike.
Immunogenic Approach Under Development by Dr Marc Azémar
Therapeutic strategies using specific antibodies in the treatment of breast and colon cancer have already yielded promising results, but the lack of well-defined tumor antigens in prostate cancer has made it more difficult to use this approach. Azémar’s treatment instead aims to activate the body’s own T-cell defense mechanism against tumor cells. Precursors to antigen-presenting cells (dendritic cells) are taken from the patient and activated in the lab in the presence of fragments of prostate-specific antigen (PSA). The precursor cells mature into active dendritic cells, and when re-introduced into the patient’s body they migrate to the lymph nodes where they induce a vigorous T-cell response against the cancerous cells.
Findings of a Pilot Study into the Azémar Treatment for Prostate Cancer
A pilot study was published in 2007 in which the Azémar treatment was assessed in 12 patients with hormone refractory prostate carcinoma. No adverse effects were observed as a result of the treatment, suggesting it is safe and feasible to continue developing this type of treatment. Two patients showed significantly reduced PSA levels following treatment, and there was regression of the disease in one patient. 21 months after treatment, the overall survival rate was 50%, which was promising considering all patients were in the advanced stages of a progressive disease.
Whilst the Azémar treatment does not yet provide a viable alternative to chemotherapy in patients with hormone refractory prostate cancer, this promising early trial suggests the technique does induce an anti-tumor response in some patients, and this should provide the basis for further research and development into similar therapeutic strategies.
 “Prostate Cancer Vaccination - An Encouraging Pilot Study” Baden-Württemberg GmBH
 “Hormone Refractory Prostate Cancer” Prostate-Cancer.com
 B Hildenbrand, B Sauer, O Kalis “Immunotherapy of Patients With Hormone-Refractory Prostate Carcinoma Pre-Treated With Interferon-Gamma and Vaccinated With Autologous PSA-Peptide Loaded Dendrtitic Cells - A Pilot Study” The Prostate 67:500-508 (2007)