Purpose: There are a significant number of patients with asymptomatic hormone-resistant prostate cancer who have increasing prostate-specific antigen (PSA) levels but little or no evaluable disease. The immunogenicity and minimal toxicity associated with cell-based vaccine therapy makes this approach attractive for these patients. Experimental Design:We have evaluated a vaccine comprising monthly intradermal injection of three irradiated allogeneic prostate cell lines (8 Â 10 6 cells each) over 1year. The first two doses were supplemented with bacille Calmette-Gue¤ rin as vaccine adjuvant. Twenty-eight hormoneresistant prostate cancer patients were enrolled. Patients were assessed clinically and PSA levels were measured monthly. Radiologic scans (X-ray, computed tomography, and bone scan) were taken at baseline and at intervals throughout the treatment period. Comprehensive monthly immunologic monitoring was undertaken including proliferation studies, activation markers, cytokine protein expression, and gene copy number. This longitudinal data was analyzed through predictive modeling using artificial neural network feed-forward/back-propagation algorithms with multilayer perceptron architecture. Results: Eleven of the 26 patients showed statistically significant, prolonged decreases in their PSA velocity (PSAV). None experienced any significant toxicity. Median time to disease progression was 58 weeks, compared with recent studies of other agents and historical control values of around 28 weeks. PSAV-responding patients showed a titratable T H 1 cytokine release profile in response to restimulation with a vaccine lysate, while nonresponders showed a mixed T H 1 and T H 2 response. Furthermore, immunologic profile correlated with PSAV response by artificial neural network analysis. We found predictive power not only in expression of cytokines after maximal stimulation with phorbol 12-myristate 13-acetate, but also the method of analysis (qPCR measurement of IFN-g > qPCR measurement tumor necrosis factor-a > protein expression of IFN-g
INTRODUCTION Only very few case reports exist regarding the incidence of prostate cancer in younger HIV-infected patients.PATIENTS AND METHODS Two incidences of HIV-infected men diagnosed with prostate cancer, from a cohort of about 200 men treated at St George's Hospital aged 40 years or more are reported. DISCUSSION On the basis of the evidence presented in both case reports and from the literature, clinicians should be aware that men with HIV infection should be considered a high-risk group for prostate cancer, and consider early PSA screening.
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