Prostate cancer: evading immunity, inspiring therapy

Prostate cancer (PCa) remains one of the most prevalent and lethal cancers in men, particularly in its metastatic form. Despite therapeutic advancements, resistance to therapy often leads to a castration-resistant state with genetic and molecular alterations that promote immune evasion and disease progression. Chronic inflammation and the immunosuppressive tumor microenvironment (TME) further exacerbate immune dysfunction. The suboptimal clinical success of current immunotherapies in advanced PCa underscores the urgent need to better understand the mechanisms underlying immune escape during disease progression and in response to therapeutic interventions. This review explores the key immune-evasive features of PCa, the contribution of the TME, and the immunotherapeutic strategies that have been clinically evaluated to improve outcomes in patients with advanced disease.