• If patients respond to hormonal treatment and then relapse, other forms of hormonal therapy are used,
  including Cytadren , hypophysectomy, androgen therapy and corticosteroids.
• If major internal organs such as the liver are involved, hormone receptors are negative or it has been less than
  two years between the primary treatment and the recurrence , chemotherapy is usually given. Standard
  combinations include CMF, CAF and CMFP (see "Stage IIIa" and "Stage IV" ). Cyclophosphamide +
  Adriamycin appears to produce similar results but has been studied less extensively. Other combinations
  include mitomycin-C + Velban as well as Velban + Adriamycin + thiotepa + Halotestin (VATH). Taxol may
  be of value in patients who fail to respond to Adriamycin (doxorubicin).
• Combination chemotherapy with or without hormone management for patients who recur after initial response
  to hormonal manipulation.

Investigational 
• If there is major organ involvement and negative hormone receptors or if less than two years has elapsed since
  primary treatment, clinical trials of combination chemotherapy, newly developed chemotherapy agents and
  biologic treatment should be considered ( see Investigational Anticancer Drugs ).
• Leuprolide is also undergoing clinical trial as a method of hormonal manipulation.
• Examples of drugs in clinical trial are anthrapyrazoles, taxotere, topotecan and monoclonal antibodies .