The NCCN guidelines note that as disease progresses, men with metastatic prostate cancer could benefit from a sequence of therapies.
|Options for Initial Therapies in the Sequence|
|The established anti-androgenic agents bicalutamide, flutamide, and nilutamide, and the newer agent enzalutamide (Xtandi, Astellas Pharma)|
|Androgen synthesis inhibitors such as ketoconazole and abiraterone acetate (Zytiga, Janssen Biotech)|
|Immunotherapy with sipuleucel-T (Provenge, Dendreon Corp.)|
|Chemotherapy with docetaxel (Taxotere and generics), cabazitaxel (Jevtana, sanofi-aventis), or mitoxantrone|
|Radiopharmaceutical therapy with radium-223|
|Supportive care with bone support (bisphosphonates and denosumab [Xgeva, Amgen]), as well as exercise, sunlight, vitamin D and calcium supplementation, palliative radiation, and/or radiopharmaceuticals|