The first line of treatment for advanced prostate cancer is Androgen (male hormone) Deprivation Therapy or ADT. Once the PSA progresses (climbs) while still on ADT and with testosterone levels <20 ng/ml a man is said to be castrate resistant. At this juncture a man will need to continue on ADT while adding additional drugs to his therapy regimen.The following is an alphabetical list of potential drugs that have been FDA approved (alphabetical because there is limited sequencing evidence available to determine the best order to take these treatments).Jevtana® (cabazitaxel) used in combination with prednisone after the failure of docetaxel therapy (chemotherapy). Usually reserved to be used after Zytiga and Xtandi, but not required. Cabazitaxel is a semi-synthetic derivative of a natural taxoid, so it is related to docetaxel, but it still works after docetaxel failure.

Novantrone® (mitoxantrone) disrupts DNA synthesis and DNA repair in both healthy cells and cancer cells. It is usually held as a drug of last resort for men with prostate cancer as it does not convey any additional survival but it can provide palliative benefits.

Provenge® (sipuleucel-T) is an autologous cellular (made of your own cells) immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer. The treatment sensitizes the immune system to prostate cancer cells. It is best used in an early disease state with a low PSA.

Taxotere® (Docetaxel “chemotherapy”) is an anti-mitotic treatment that interferes with cell division, especially fast growing cells. It encourages apoptosis, or programmed cell death.

Xofigo® (Radium-223 chloride) is an alpha emitting radio (short range radiation) pharmaceutical that seeks out bone metastases. It is used in men with symptomatic bone metastases and no known visceral metastatic disease.

Xtandi® (Enzalutamide aka MDV3100) is an androgen receptor antagonist drug, or a drug that blocks the cancer cells from absorbing and using the androgens that are being manufactured in the body. Approved only in the post-chemotherapy disease state. Sometimes, it is referred to as a “super” Casodex because of its similar, but souped up action.

Zytiga® (abiraterone) plus prednisone is used to treat men who have mCRPC. It is approved for both pre-chemotherapy and post-chemotherapy (docetaxel failure) disease states. It works by blocking the production of androgens from three sources; testicular, adrenal, and prostatic tumor tissues.

All the list drugs have the possibility of having many different and significant side effects. Before starting any of these drugs talk to your oncologist and learn about which side effects are serious and should be reported to the doctor or for which you should proceed to an emergency room for assistance. When in doubt, act – call the doctor or go to the emergency room.

Joel T. Nowak, M.A., M.S.W.