Table 1 Different classes of drugs presently used to cure PC

Taxane derivatives (Antimicrotubular agent)

Docetaxel

Docetaxel is a microtubule stabilizing taxane that inhibits microtubular assembly in cancer cells

75 mg/m² once in every three weeks for six cycles, it is injected intravenously

Major side effects are nausea, vomiting, alopecia, neutropenia, fluid retention, gastrointestinal complications

[33, 34]

Cabazitaxel

Cabazitaxel is a novel taxane-based chemo drug that blocks the mitosis of cancer cells at the metaphase anaphase transition by inhibiting the assembly of tubulin and induction of apoptosis

Used to treat advance stage prostate cancer, 20–25 mg/m² is injected intravenously once every three weeks for six cycles

Side effects reported are neutropenic complications, fatigue, weakness, and diarrhea

[35, 36]

Anthracenedione derivatives (Alkaloids-cytotoxic agents)

Mitoxantrone

Mitoxantrone is a synthetic anthracenedione that has a variety of modes of action as it suppresses the T cells, B cells, and macrophages proliferation. It affects antigen presentation and reduces the inflammatory cytokines secretion. It is also an inhibitor of topoisomerase

The recommended dose is 12 mg/m² intravenous infusion every three weeks

Cardiomyopathy, reduction in WBC count, discoloration of urine, and bleeding issues. Other common side effects are nausea, hair loss, and urine infections

[37, 38]

Androstane derivatives (Cytochrome P450 17A1 inhibitor)

Abiraterone acetate

Abiraterone is an androgen biosynthesis inhibitor that inhibits the 3-β hydroxysteroid dehydrogenase (3βHSD) mediated conversion of DHEA to androgen

It is orally administered 1000 mg daily with 10 mg of prednisone

Increased levels of mineralocorticoids lead to increased levels of k⁺ and hypertension. This issue is managed with the use of amiloride along with abiraterone

[39, 40]

Phenyl imidazolidine derivatives (Androgen receptor antagonist)

Enzalutamide

Enzalutamide is a second-generation antiandrogen that primarily targets the androgen signaling pathway. It is an AR blocker, so biosynthesis of androgen is reduced

It is orally administered at 160 mg daily

Fatigue, diarrhea, hot flushes, back pain, and hypertension

[41, 42]

Radiopharmaceutical agent

Radium-223

Radium-223 is an α-emitting radionucleotide that targets bone metastases in mCRPC patients

Four weekly intravenous infusions of 55 kBq/kg are administered for six cycles

Blood-related disorders like thrombocytopenia, anemia, and leukopenia have been reported. Some common side effects include fatigue and ostealgia

[43]

Therapeutic vaccines

Sipuleucel-T

Sipuleucel-T is an autologous cellular immunological agent

It is a cancer vaccine administered through leukapheresis. The infusion is given three times in a gap of two weeks

Arrhythmia, fever, pain due to blood clots, swelling, and chest pain

[44]