We previously reported that personalized peptide vaccine (PPV) therapy in combination with leutenizing hormone-releasing hormone (LH-RH) analog and estramustine phosphate in certain cases is safe and capable of inducing both immune responses and clinical responses for metastatic castration-resistant prostate cancer (CRPC) patients. In the present study, PPV monotherapy was given to CRPC patients. Twenty-three patients with metastatic CRPC were treated with PPV without any additional treatment modalities, including LH-RH analogs. Samples were analyzed for peptide-specific cytotoxic T-lymphocyte (CTL) precursor analysis and peptide-reactive IgG. Toxicity and immunological and clinical responses were assessed on a three-monthly basis. Seventeen patients were available for immunological and clinical evaluation. The vaccines were well tolerated, with grade 3 erythema at injection sites in only one patient. Augmentation of CTL or IgG responses to at least one of the peptides was observed in six of 17 (35%) and 15 of 17 (88%) patients tested, respectively. Among 57 peptides used, 9 and 36 peptides induced CTL and IgG responses, respectively. Delayedtype hypersensitivity reaction was observed in eight of 17 patients. More than 30% prostate-specific antigen (PSA) decline was observed in four of 17 patients. Of these, one patient achieved a complete PSA response and another patient showed a partial PSA response with profound shrinking of lymph node metastases and prostate. The overall median survival time was 24 months (range, 5-37 months). These results suggest that PPV monotherapy appears to be safe and capable of inducing peptide-specific immune responses and clinical responses in CRPC patients. This trial was registered with University Hospital Medical Information Network (UMIN) number R000003339. (Cancer Sci 2010; 101: 601-608) T he prognosis for patients with castration-resistant prostate cancer (CRPC) remains poor, even though treatment with docetaxel-based chemotherapy moderately increases survival.(1,2) To overcome the poor efficiency of current treatment options, new experimental therapies such as gene therapy, targeted cancer therapy, and immunotherapy have been explored. Although the concept of immunotherapy is not new, recent advances in the field, particularly in the development of cancer vaccines, have renewed the enthusiasm for vaccine-based treatments, also in tumor types that are not considered inherently immunogenic. This has led pharmaceutical companies to carry out a number of vaccine clinical trials. In a phase III clinical trial with dendritic cell-based vaccinations for asymptomatic metastatic CRPC patients, treated patients showed a significantly longer overall survival as compared to those receiving the placebo.(3) In another large clinical trial, patients received allogenic tumor cell-based vaccines.(4) Interim analysis, however, revealed worsened survival in the treatment arm, whereupon the trial was terminated (see http://clinicaltrials.gov/ct2/show/ NCT00133224). More encouraging are the n...