The treatment of advanced prostate cancer, and in particular castrate resistant prostate cancer (CRPC), has changed greatly over the last 4 years. Treatment options have expanded and now offer multiple treatment possibilities that did not exist 4 years ago. With the addition of all these new options, so comes the addition of significant economic costs, for instance:

• Provenge: Now almost $100,000 for a standard course of 3 treatments.
• Cabazitaxel: The usual 6 cycles cost about $50,000.
• Zytiga: An 8-month course of treatments costs about $47,000.
• Xtandi: A typical eight-month treatment costs nearly $60,000.
• Xofigo: 6 injections for the cost of $69,000.

Our insurance companies (payers) are all bracing for increased cost to treat men with advanced prostate cancer, many of whom will undoubtedly use some if not all of these new agents either in sequence or in some combination. This will pose a dilemma for payers that attempt to manage the treatment costs