Available second line therapeutic modalities in relapse prostatic cancer are alternative endocrine manipulations, chemotherapy, combine endocrine and cytotoxic therapy, new drugs, radiation therapy, and general antitumour and supportive care. The details of this therapeutic modalities will not be discussed in this article.

Hormone escape is a gradual event. Biochemical changes such as a rise in prostate specific antigen (PSA), might occur long before progression symptoms showed up clinically. Questions regarding treatment, i.e., whether to start treatment when the level of PSA is increasing, when an asymptomatic new hot spot appears on a routinely performed whole body bone scan, or when the patient again becomes symptomatic, will influence the period of survival time.

Whatever the therapeutic modalities used in relapse prostate cancer, the results remain very disappointing for patients and physicians alike. Whatever the second line regimen is used, the responses are quite similar, rarely lasting more than six months. This is one reason to postpone second line therapy until patient become symptomatic. Since we are unable to cure these patients we should offer the most acceptable and affordable palliative treatment for these patients. Quality of survival is more important than the length of survival.