As a medical oncologist, a major proportion of the patients I care for are those men in whom androgen deprivation or hormone therapy has stopped working. Those men are referred to me or seek my consultation wondering, “Is there anything else to do when hormone therapy does not work?”
One of the most important messages I convey to such patients on the very first visit is there are a number of new treatments that are available. Despite activity of the cancer after androgen deprivation or suppressing testicular production of androgens, there are other hormone approaches. There are agents such as ketoconazole which can turn off androgen production by other sources in the body. There are chemotherapies. There are vaccines. So I think there is no question that the approach to men in whom cancer has gotten active despite initial hormone therapy still has many approaches available and treatments that clearly can improve the quality and length of survival.