When hormone resistance is present, sequentially more potent hormonal agents such as Nilutamide, Ketoconazole, Zytiga or estrogen are often employed. If these are ineffective or if the disease is already dangerously advanced, chemotherapy with Taxotere, Taxotere combinations or Jevtana may be indicated. Disease that is more slowly progressing can be treated with Provenge.
A variety of supportive medications may be appropriate. Zometa and Xgeva strengthen the bones. Neulasta and Leukine fortify the immune system. Procrit and Aranesp treat anemia. Judicious beam radiation effectively controls bone pain. Several investigational agents, XL-184, MDV-3100, Ipilimumab and Curstersin are available via clinical trials and appear very promising.
Close monitoring with frequent bone and body scans and blood tests (PSA, PAP, ALP, LDH) is necessary to determine if the treatment is working. Effective treatment makes blood markers stabilize or decline. Markers that fail to stabilize or decline within 60-90 days after initiating a new treatment are indicating that treatment is ineffective and needs to be changed.