Hormone refractory disease is a misnomer. recent work has shown that prostate cancer is still hormone sensitive but has become extremely sensitive to the most minute amounts of androgens. Therefore these cancers are still responsive to hormones but we dont have the technology/drugs to take advantage of it. ZD4054 aberaterone act on a different mechanism and can affect these androgen sensitive cells. Our conventional definition of hormone refractory included those substances that produced androgen blockade ie castration, lhrh agonists, casodex et al, nizoral etc.

I believe it is true that one of the newer agents may be tried before provenge but that in the long run it wont matter as far as sales are concerned. Furthermore these agents dont exist in a vacuum neaning combinations will be tried. The label for provenge wont include patients to have failed zd4054 aberaterone. So i can invisio both being used sequentially or concomatanly. The latter in view of the fact that neither is curative.

In the distant future both provenge and these newer agents will be tried in earlier stage high risk patients. Hormone treatment already has been shown to improve survival in high risk irradiated patients as compared radiation alone. I can see the rtog encorporating aberaterone in a next generation of trials. Provenge is considerably more expensive so its inclusion in earlier disease depends upon dndncash flow and the time it would take to complete such a trial. (patent on provenge runs out in 2020)