外照射放疗用于根治器官局限性前列腺癌并治疗转移性疾病的病变，而使用标记的前列腺特异性膜抗原配体和镭 223 (223Ra) 的分子放疗适用于转移性前列腺癌，并已显示出显着的改善与标准护理治疗相比，症状控制和总体生存率有所提高。前列腺癌被认为是一种免疫冷肿瘤，因此调查治疗引起的免疫反应影响的研究已经完成。然而，新出现的数据支持放射治疗在前列腺癌中诱导免疫反应的观点，但该反应是抗肿瘤反应还是促肿瘤反应取决于放射治疗方案，并且还取决于细胞系。体外数据表明，单剂量放疗方案比分次放疗方案产生更大的免疫抑制作用；关于分子放射治疗药物诱导的免疫反应知之甚少，但有证据表明，这些药物可能会诱导免疫抑制性全身免疫反应，表现为抑制性检查点分子（例如程序性细胞死亡 1 配体 1 和 2）表达增加，并且这些变化可能与临床反应有关。不同的放疗方式可以诱导不同的免疫特征，从而激活或抑制免疫介导的肿瘤杀伤作用，并且当前用于前列腺癌研究的临床前模型对于研究放疗诱导的免疫反应的复杂性还不是最佳的。© 2024. Springer自然有限公司。

External beam radiotherapy is used for radical treatment of organ-confined prostate cancer and to treat lesions in metastatic disease whereas molecular radiotherapy with labelled prostate-specific membrane antigen ligands and radium-223 (223Ra) is indicated for metastatic prostate cancer and has demonstrated substantial improvements in symptom control and overall survival compared with standard-of-care treatment. Prostate cancer is considered an immunologically cold tumour, so limited studies investigating the treatment-induced effects on the immune response have been completed. However, emerging data support the idea that radiotherapy induces an immune response in prostate cancer, but whether the response is an antitumour or pro-tumour response is dependent on the radiotherapy regime and is also cell-line dependent. In vitro data demonstrate that single-dose radiotherapy regimes induce a greater immune-suppressive profile than fractionated regimes; less is known about the immune response induced by molecular radiotherapy agents, but evidence suggests that these agents might induce an immune-suppressive systemic immune response, indicated by increased expression of inhibitory checkpoint molecules such as programmed cell death 1 ligand 1 and 2, and that these changes could be associated with clinical response. Different radiotherapy modalities can induce distinct immune profiles, which can either activate or suppress immune-mediated tumour killing and the current preclinical models used for prostate cancer research are not yet optimal for studying the complexity of the radiotherapy-induced immune response.© 2024. Springer Nature Limited.