Prostate cancer is the second leading cause of cancer death in men in the 
western world. Most deaths will occur due to the progression of cancer into a 
hormone refractory state. Until recently, docetaxel-based chemotherapy was the 
only established treatment (shown to increase survival) for patients with 
metastatic hormone refractory prostate cancer. The improved understanding of 
prostate cancer biology in recent years led to the development of drugs directed 
against precise tumorigenesis-associated molecular pathways, and significant 
expansion of treatment horizons for these patients. In 2010-2011, three more 
agents, with different mechanisms of action, were shown to be associated with a 
survival benefit in mHRPC, including the dendritic cell vaccine sipuleucel-T 
(immunotherapy), the 17,20 lyase inhibitor abiraterone (hormonal therapy), and 
the taxane cabazitaxel (chemotherapy). A fourth agent, denosumab (bone targeted 
therapy) was also recently approved by the FDA for patients with bone metastasis 
after showing a reduction in the occurrence of skeletal-related events. This 
review will focus on recent advances in the standard treatments paradigm in 
mHRPC.