Medical Minute 7-13: A New Prostate Cancer Treatment

By: Vanessa Welch Email
By: Vanessa Welch Email

57-year-old Robert Obin says he may be a cancer patient, but he doesn't want to look like one. He loves clothes an compliments.

For seven years, he's tried everything to fight an aggressive prostate cancer that spread to his bones. He says radiation was the worst.

"Vomiting. I can't eat. I can't sleep. I said to the guy, 'I don't think I'm going to continue because I can't take it anymore,' said Robert Obin.

At Mount Sinai Comprehensive Cancer Center, doctors offered him a new treatment using his own blood, called Provenge. The blood goes to a lab where specific immune T-cells are collected and exposed to proteins similar to his prostate cancer. Then they're put back in to the patient to fight the cancer.

"When those cells go back into the body, your own immune system sees these proteins and then creates cells to attack that protein," said Joseph Pizzolato, M.D., Medical Oncologist at Mount Sinai Comprehensive Cancer Center.

In trials, this active cellular immunotherapy increased patients' lifespan by an average of four month.

"The disease takes on a new character in that it slows down significantly, offering survival advantages similar and sometimes better than conventional chemotherapies."

Robert's a believer.

"It's not going to cure me, but that will help me to give me, I don't know, more days?"

A hopeful, late-stage cancer patient who isn't giving up any time soon.

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500,


BACKGROUND: The prostate is a gland in the male reproductive system that produces the majority of fluid that makes up semen -- the thick fluid that carries sperm. The walnut-sized gland is located beneath a man's bladder and surrounds the upper part of the urethra, which is the tube that carries urine from the bladder. Prostate function is regulated by testosterone, a male sex hormone produced mainly in the testicles. Prostate cancer is a major health concern for American men. Although the disease is rare before age 50, experts believe that most elderly men have at least traces of it. Prostate cancer cells do not follow normal patterns and grow uncontrollably and spread to other tissues. It is typically a very slow-growing tumor, often causing no symptoms until advanced stages. (SOURCE: WebMD)
STANDARD TREATMENT: Late-stage prostate cancer happens when the condition has spread beyond the prostate, and there are fewer options for treatment. The most common recommended late-stage treatment is orchiectomy. This is when one or both of the testicles are surgically removed. This is because the cancer has spread not only to the entire prostate but also to the testicles and other surrounding parts. Removing the major source of testosterone that helps the spread of the cancer is thought to help the patient survive the condition. Other late-stage treatments include hormone therapy. When this proves ineffective in treating the illness, chemotherapy and radiation are often recommended. (SOURCE:

NEW TREATMENT: Provenge is a breakthrough prescription medication for certain men with advanced prostate cancer. It is the first prostate cancer therapy approved by the Food and Drug Administration and is designed to work differently from hormone therapy or chemotherapy. Provenge is the first autologous cellular immunotherapy, meaning it uses the patient’s immune system to fight the cancer. Your immune system is made up of immune cells found in your blood. These cells work as your body’s natural defense against all types of illness.

HOW IT WORKS: The patient’s personalized dose of Provenge consists of his own immune cells that have been activated by a recombinant antigen to seek and attack prostate cancer cells. By stimulating the natural ability of immune cells already in the blood, Provenge may help certain men with advanced prostate cancer live longer. In a clinical trial, this therapy reduced the risk of death from prostate cancer by 22.5 percent in men who received treatment. Treatment includes three doses, given two weeks apart. After three infusions, treatment is complete.

Joanna Palmer, Public Relations
Mount Sinai Medical Center
(305) 674-2589


Joseph Pizzolato, M.D., a medical oncologist at Mount Sinai Comprehensive Cancer Center, tells us about a new treatment for prostate cancer.

Tell me what group of patients are we talking about with Provenge therapy. Which patients are we trying to address?

Joseph Pizzolato, M.D.: Today, we are talking about patients with prostate cancer who have failed hormonal therapies in whom their prostate cancer has returned.

Before this treatment came along what was available to those patients?

Joseph Pizzolato, M.D.: Those patients, typically, would go on chemotherapy prior to programs being approved.

Tell me about the challenges (these patients may face) when their prostate cancer comes back.

Joseph Pizzolato, M.D.: Lots of patients, when their prostate cancer comes back, have to undergo hormonal therapy. Once that therapy has failed, often times they are still feeling quite well. Unfortunately, the only alternative at that time is chemotherapy, which as you know, has a tremendous number of side effects especially for patients who aren’t feeling quite well.

What is this new therapy that was recently approved by the FDA?

Joseph Pizzolato, M.D.: Prostate cancer is what we call an immuno-evasive disease. Typically, it’s evaded our own immune system. What Provenge therapy does is it takes the patient’s own immune cells, activates them within a lab so to speak, so that the immune system can be introduced to a protein similar to that of the prostate cancer. These cells are then put back into the patient whereby the patient’s own immune system can evolve a robust response to the prostate cancer. The cells begin to attack the prostate cancer as if it were an infection. Because each dose is made up of the patient’s own immune cells, no two doses are ever the same.

So, walk me step by step of what you do.

Joseph Pizzolato, M.D.: Patients will typically come in and once the arrangements have been made, their blood cells will be collected. They’re specifically trying to pull the immune system cells.. They are then sent to another facility where, in a lab, those cells are exposed to certain proteins similar to their prostate cancer. Within three days their own cells are presented back to them just like a blood transfusion. This is done every two weeks and it’s done three times.

By going through this process in the lab, what are you putting back into that person’s body?

Joseph Pizzolato, M.D.: We’re actually putting back the same cells that belong to the patient that we took out. The difference is that these cells have now been exposed to certain proteins that are on the surface of prostate cancer cells. When those cells go back into the body, your own immune system sees these proteins and then creates “super-charged” T-cells to attack that protein.

What kind of responses do you see in patients? What does it do for the patient?

Joseph Pizzolato, M.D.: Generally speaking, we don’t see responses in the very conventional way in terms of the PSA going down tremendously or tumors shrinking, but rather we see the cancer’s progress slow down significantly offering survival advantages similar and sometimes better than conventional chemotherapies.

Without a lot of the horrible side effects.

Joseph Pizzolato, M.D.: Exactly, without a lot of the horrible side effects.

In essence, are you are trying to buy time for these patients? Tell me about that. When there is a recurrence of prostate cancer obviously the patients first question is, “How much time am I going to have?”

Joseph Pizzolato, M.D.: The amount of time that a patient has with any metastatic disease is often difficult to know. Some patients have lived with metastatic cancers for a long time. And the reason why they have lived with their disease for a long time probably has a lot to do with the biology of their disease and how their immune system effects the biology of the disease. Slowing down the cancer, and allowing the body to fight that disease can have a significant impact on how long they live and also the quality of life they have.

Chemo is still an option if this doesn’t have a robust enough effect. You still have other options right?

Joseph Pizzolato, M.D.: Chemo is definitely an option once the Provenge has been administered if the disease is still moving and needs to be treated. We do feel that the effect of the Provenge therapy, even with the chemo, is still enhanced. In other words, we believe that the cancer’s growth still can be slowed down.

Are you familiar with the studies before the FDA approved this? Do you know what percentage of men respond to this kind of therapy?

Joseph Pizzolato, M.D.: Again, responses in this therapy are difficult to say. The vast majority of patients don’t have a classic response of PSA going down, which is what lots of patients do and how they monitor their disease. But it’s far more important to assess how long patients live. Short-lived responses don’t make patients live longer, but we know based on trials with Provenge therapy patients live much longer than the patients who don’t have Provenge therapy.

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