Treatments for Hormone Refractory Prostate Cancer

Second-Line Hormonal Therapies

Chemotherapy

Radiation Therapy

There are three general categories of treatments for men with hormone refractory prostate cancer. The 2nd line hormonal therapies list includes drugs not usually listed as being a 2nd line treatment, but nevertheless they can play a role in either slowing down HRPC progression or lessening the tumor burden.

Second-line hormonal therapies. A list of what can be found on the 2nd-Line Hormonal Therapy web page is below. These are all documented with data from clinical trials, although in many cases the number of patients is small. Go to the 2nd-line hormonal therapy page for ketoconazole, DES and TDE and to the Proven-Other page for the remainder, noting that the "Other" category simply means that they are less proven than the standard 2nd line therapies -- they might lengthen the PSA doubling time, some might have PSA declines of less than 50% or provide a stable disease state. Here's the complete list:

Ketoconazole (Low dose, Intermediate Dose and High Dose,); Generic.

DES (obtain from compounding pharmacy). Low cost.

Transdermal Estrogen Patches (estradiol - TDE) and other estrogens (regular prescription items).

Low dose corticosteroids such as dexamethasone, prednisone, hydrocortisone and triamcinolone.

Leukine and leukine combinations (leukine = gm-csf). Very expensive

Sandostatin LAR. Very expensive.

Avodart plus ketoconazole

Nilutamide (an alternative antiandrogen).

Revlimid and Ketoconazole or leukine and revlimid (Revlimid is very expensive).

Sunitinib (Sutent). Very expensive

Degarelix (Firmagon). A GnRH antagonist that might be better than e.g. Lupron

Chemotherapy. This is an extensive set of papers and tables covering use of chemotherapy with HRPC. The main focus has been on identifying chemotherapy that is effective as a 2nd line or greater chemotherapy since taxotere is an approved drug as a 1st line chemotherapy.

Radiation. Covered here are spot radiation, radiopharmaceuticals and more.

Author: Howard Hansen 11/30/2008; updated 16 July 2010

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