Most prostate neoplasias are relatively non-invasive and slow-growing – the 5-year survival rate is over 98%. The relatively slow progression and late onset of most prostate tumors means that many men live to old age despite diagnosis. Some prostate tumors, however, are much more aggressive than usual or are resistant to conventional treatment, posing serious therapeutic challenges to clinicians. As a rule, hormonal and chemotherapy are mostly applied when the tumor has metastasized outside the prostate, while radiation therapy is considered more of an alternative in early stages. Some exceptions are also possible, in which radiation therapy is applied to tumors in advanced stages, and hormone therapy – to tumors in early stages. Cryotherapy, hormone therapy, or chemotherapy may be used if other alternatives fail and the tumor continues to grow. Some hormone-dependent tumors become resistant to hormone therapy and begin to grow 1-3 years after its initiation. This presents a therapeutic dilemma for the treating clinician who must decide what further treatment should be. The chemotherapeutic agent docetaxel has shown some therapeutic benefit in such neoplasias, increasing survival by an additional 2–3 months. In 2004, it was approved by the US Food and Drug Administration (FDA) for the indication hormone refractory (resistant) prostate cancer. This makes it the first chemotherapy drug to be shown to increase survival in such tumors. In 2010, the FDA also approved cabazitaxel for this indication. Combinations of bevacizumab, docetaxel, thalidomide, and prednisone have also been used. NEWS_MORE_BOX In 2010, the drug abiraterone completed phase III clinical trials in patients who had failed chemotherapy. The results showed an increase in survival by an average of 4.6 months. In 2011, the FDA approved the combination of abiraterone and prednisone for the treatment of metastatic hormone-refractory cancer in patients previously treated with docetaxel. More recently, enzalutamide has been approved as a second-line treatment and improves survival in metastatic, refractory prostate cancer. Abiraterone and enzalutamide are currently undergoing trials to determine their efficacy as first-line drugs. Sipuleucel-T has recently become available in some countries – an immunotherapeutic agent prepared individually for each patient. Clinical trials have shown that it prolongs survival in metastatic cancer, but the treatment is extremely expensive. The scientists found that only certain groups of tumor cells were affected by the drugs, while others continued to divide almost unchanged. This is fueling the search for new drugs that work by new mechanisms and stop larger groups of tumor cells from growing or dividing.