sipuleucel-t with or without radiation therapy in treating patients with hormone-resistant metastatic prostate cancer

Conditions: Adenocarcinoma of the Prostate; Bone Metastases; Hormone-resistant Prostate Cancer; Recurrent Prostate Cancer; Soft Tissue Metastases; Stage IV Prostate Cancer

Summary: this randomized phase ii trial studies how well giving sipuleucel-t with or without radiation therapy works in treating patients with hormone-resistant metastatic prostate cancer. vaccines may help the body build an effective immune response to kill tumor cells. radiation therapy uses high energy x rays to kill tumor cells. it is not yet known whether giving sipuleucel-t vaccine is more effective with or without radiation therapy in treating prostate cancer

primary objectives: i. to assess the feasibility, based on percent able or willing to receive all three infusions of sipuleucel-t immunotherapy, when combining sipuleucel-t with radiation therapy to a single site of metastasis delivered one week prior to beginning of sipuleucel-t therapy. secondary objectives: i. to assess the effect of radiation therapy to single metastasis on immune response (antibody and t-cell proliferation to prostate acid phosphate \[pap\] and fusion protein pa2024) generated by sipuleucel-t immunotherapy. ii. to assess the effect of external beam radiotherapy to single metastasis on prostate specific antigen (psa) response to therapy with sipuleucel-t. iii. to assess the effect of external beam radiotherapy to single metastasis on radiographic response rate to therapy with sipuleucel-t. iv. to assess the time from the onset of therapy with sipuleucel-t +/- radiation to the need for subsequent therapy for prostate cancer. v. to assess the toxicity associated with sipuleucel-t +/- radiation. outline: patients are randomized to 1 of 2 treatment arms. arm a: patients receive sipuleucel-t intravenously (iv) over 60 minutes days 22, 36, and 50. arm b: patients undergo external beam radiation therapy in weeks 1-2. patients also receive sipuleucel-t as in arm a. in both arms, treatment continues in the absence of disease progression or unacceptable toxicity. after completion of study treatment, patients are followed up until week 60.

Eligibility criteria:
inclusion criteria: * histologically documented adenocarcinoma of the prostate * life expectancy of \>= 6 months, eastern cooperative oncology group (ecog) performance status =\< 2 * metastatic disease as evidenced by soft tissue and/or bony metastases on baseline bone scan and/or computed tomography (ct) scan or magnetic resonance imaging (mri) of the abdomen or pelvis * castration resistant prostatic adenocarcinoma; subjects must have current or historical evidence of disease progression despite castrated level of testosterone (\< 50 ng/dl) achieved by orchiectomy or luteinizing hormone-releasing hormone (lhrh) agonist or antagonist therapy; disease progression has to be demonstrated by psa progression or progression of measurable disease or progression of non-measurable disease as defined below: * psa: two consecutive rising psa values, at least 7 days apart * measurable disease: \>= 20% increase in the sum of the longest diameters of all measurable lesions or the development of any new lesions; the change will be measured against the best response to castration therapy or against the pre-castration measurements if there was no response * non-measurable disease: * soft tissue disease: the appearance of 1 or more lesions, and/or unequivocal worsening of non-measurable disease when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response * bone disease: appearance of 2 or more new areas of abnormal uptake on bone scan when compared to imaging studies acquired during castration therapy or against the pre-castration studies if there was no response; increased uptake of pre-existing lesions on bone scan does not constitute progression * white blood cell (wbc) \>= 2,500 cells/ul * absolute neutrophil count (anc) \>= 1,000 cells/ul * platelet count \>= 75,000 cells/ul * hemoglobin (hgb) \>= 9.0 g/dl * creatinine =\< 2.5 mg/dl * total bilirubin =\< 2 x institutional upper limit of normal (uln) * aspartate aminotransferase (ast, serum glutamic oxaloacetic transaminase \[sgot\]) and alanine aminotransferase (alt, serum glutamate pyruvate transaminase \[sgpt\]) =\< 2.5 x institutional uln * prior chemotherapy with 0-2 regimens is allowed * prior radiation therapy to prostate or prostate bed is allowed provided it occurred \> 3 months before enrollment to the study exclusion criteria: * the presence of liver, or known brain metastases, malignant pleural effusions, or malignant ascites * moderate or severe symptomatic metastatic disease, defined as a requirement for treatment with opioid analgesics for cancer-related pain within 21 days prior to registration * eastern cooperative oncology group (ecog) performance status \> 2 * treatment with chemotherapy within 3 months of registration * treatment with any of the following medications or interventions within 28 days of registration: * systematic corticosteroids; use of inhaled, intranasal, and topical steroids is acceptable * any other systemic therapy for prostate cancer (except for medical castration) * history of external beam radiation therapy to metastatic sites within 1 year of enrollment to the study * participation in any previous study involving sipuleucel-t * pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography \> 50%) or spinal cord compression * concurrent other malignancy with the exception of: * cutaneous squamous cell and basal carcinomas * adequately treated stage 1-2 malignancy * adequately treated stage 3-4 malignancy that has been in remission for \>= 2 years at the time of registration * a requirement for systemic immunosuppressive therapy for any reason * any infection requiring parenteral antibiotic therapy or causing fever (temperature \> 100.5 degrees fahrenheit \[f\] or 38.1 degrees celsius \[c\]) within 1 week prior to registration * any medical intervention or other condition which, in the opinion of the principal investigator could compromise adherence with study requirements or otherwise compromise the study's objectives