Mapping research trends in macrophage polarization and immunotherapeutic potential in prostate cancer: a bibliometric and visual analysis

Background Macrophage polarization plays a critical role in shaping the immunosuppressive tumor microenvironment (TME) of prostate cancer (PCa). Tumor-associated macrophages (TAMs), particularly those exhibiting immunoregulatory and tumor-promoting transcriptional programs, contribute to disease progression, immune evasion, and therapeutic resistance. Objective To comprehensively map the research landscape of macrophage polarization and activation in PCa using bibliometric tools and to assess translational progress through a review of clinical trials. Methods A bibliometric analysis was conducted using VOSviewer, CiteSpace, and R, based on publications related to macrophage polarization and activation in PCa. Additionally, eligible interventional clinical trials in prostate cancer were identified through predefined searches of ClinicalTrials.gov and PubMed, and 20 trials were included in the descriptive synthesis. Results Bibliometric findings revealed growing research interest in macrophage polarization since 2015, with key themes including immune suppression, cytokine signaling, and therapeutic resistance. High-frequency keywords highlighted macrophage plasticity/heterogeneity (often captured by M1/M2-related terms in the literature), immune checkpoints, and TME reprogramming. Clinical trials investigated a range of strategies, including CSF1R inhibition (e.g., cabiralizumab, PLX3397), TAM reprogramming strategies, checkpoint blockade, and combination therapies with PARP inhibitors, radiotherapy, and vaccines. Conclusion The integration of bibliometric insights with clinical trial and published data highlights the increasing translational focus on TAM/TME-targeted therapies in PCa. These findings underscore macrophage polarization as a promising immunotherapeutic axis and emphasize the need for further clinical innovation and biomarker-driven strategies.