Perspectives on treatment of metastatic castration-resistant prostate cancer

Abstract

The arrival of several new agents--cabazitaxel, abiraterone acetate, enzalutamide, and radium-223--is changing the treatment options and management of patients with metastatic castration-resistant prostate cancer (mCRPC). Many other novel agents are also being investigated. As new drugs become approved, new treatment strategies and markers to best select which patients will best respond to which drug are needed. This review article is a summary of a European Treatment Practices Meeting, which was convened to discuss these latest data on novel agents and current treatment strategies in the mCRPC setting.

Keywords: Abiraterone acetate; Cabazitaxel; Docetaxel; Enzalutamide; Metastatic castration-resistant; Prostate cancer; Treatment.

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.

Treatment algorithm for patients with metastatic castration-resistant prostate cancer who relapse after 6–8 cycles of docetaxel. Asterisks indicate treatment options that are affected by funding and availability in some countries. Abbreviations: mCRPC, metastatic castration-resistant prostate cancer; PSA DT, prostate-specific antigen doubling time.

Figure 2.

Current and possible future sequencing of drugs in castration-resistant prostate cancer in Europe. Abbreviations: GNRH, gonadotropin-releasing hormone; LHRH, luteinizing hormone-releasing hormone; mCRPC, metastatic castration-resistant prostate cancer.

Figure 3.

Treatment algorithm for older men with metastatic castration-resistant prostate cancer (≥70 years of age). Adapted from [93] with permission to include novel treatment options.* Abbreviations: CSIR-G, Cumulative Scoring Index Rating–Geriatrics; IADL, Instrumental Activities of Independent Daily Living.