Hi I'm Dr. Scholz. A common question we get at the PCRI is what is
Provenge? Provenge is FDA-approved immunotherapy for prostate cancer. It's
been on the market for a number of years now it's the first immunotherapy
approved for prostate cancer and as of yet is the only one approved. Provenge is
a very clever methodology where the immune recognition cells in your blood
are removed in a dialysis type process called plasmapheresis at a specialized
facility and those cells are then transported to Seal Beach, California and
mixed with components that make them recognize and get angry at prostate
cancer cells. Once that's accomplished, they're put in the bag sent to the
doctor's office and the patient is scheduled to meet when the bag arrives
and then that is reinfused. So his own immunotherapy cells are reinfused, but now they're awakened to attack
prostate cancer. When Provenge was originally FDA-approved it actually went
through two randomized prospective trials to validate its effectiveness.
This is where a third of the people would get a sham infusion, two-thirds
would get the real stuff, and consistently both trials showed
prolonged survival in the people that got Provenge. The really nice thing about
Provenge is that the side-effects from this
treatment are quite mild. You may have some fever and chills for a day or you
may really feel nothing at all. The other thing is the convenience of
administration. Three such visits that I described occur on a Q two week basis and
the whole thing is over in four to six weeks. One of the things that confuses
people about Provenge is when you look at most treatments for prostate cancer
if the treatments working the PSA drops. With Provenge what seems
to be happening is instead of a radical reversal of the disease, the enhanced
immune reaction against prostate cancer retards the progression of
the disease. So whereas with a lot of chemotherapy poisons or hormone therapy
the cancer cells were killed off and then over a period of time they figure
out how to handle it then they grow back. With immunotherapy what we often see is
that the cancer cells aren't killed off in mass but that they don't grow as well
or as quickly after the immune system gets engaged. This question of PSA
responses has raised a lot of controversy about Provenge, and perhaps
some of that has been dissipated now that there's another life prolonging
agent on the market called Xofigo that also does not consistently lower
PSA levels. So this idea of retarding the disease progression rather than killing
off massive number of cells in mass and then waiting for them to figure out how
to grow again is starting to be understood and people
are getting more comfortable with the reality that this non-toxic, easy to
apply medicine is truly beneficial. So are all prostate cancer patients
eligible for Provenge? Well if you have a lot of money. It's an expensive treatment,
but typically insurance companies will cover it in people that have developed
some sort of spread outside the prostate—a metastatic lesion—and have become
resistant to Lupron. I use Lupron as a it's kind of the Kleenex of hormone
therapies—Trelstar, Eligard, Firmagon, Zoladex, and Lupron. All these medicines work
by stopping the production of testosterone in the testicles. So if PSA
levels are rising, if there's a metastatic lesion somewhere, and you've
been on Lupron or a Lupron-like drug your insurance should cover Provenge
because it's FDA approved for that type of prostate cancer patient. So in summary
Provenge is a almost non-toxic very effective and
efficacious treatment for prostate cancer. If you haven't heard of it, be
aware of it, and particularly if you have a rising PSA on Lupron you should look
at the possibility of getting some Provenge
to improve your longevity