Advances in Therapy

, Volume 30, Issue 12, pp 1041-1066

First online:

Evolution of the Treatment Paradigm for Patients with Metastatic Castration-Resistant Prostate Cancer

  • Zafar MalikAffiliated withClatterbridge Cancer Centre NHS Foundation Trust Email author 
  • , Heather PayneAffiliated withUniversity College London Hospitals
  • , Jawaher AnsariAffiliated withBeatson West of Scotland Cancer Centre
  • , Simon ChowdhuryAffiliated withGuy’s and St Thomas’ NHS Foundation Trust
  • , Mohammad ButtAffiliated withQueens Centre for Oncology and Haematology, Castle Hill Hospital
  • , Alison BirtleAffiliated withRosemere Cancer Centre, Lancashire Teaching Hospitals
  • , Santhanam SundarAffiliated withNottingham University Hospitals NHS Trust
  • , Chinnamani Vee EswarAffiliated withClatterbridge Cancer Centre NHS Foundation Trust
  • , Simon HughesAffiliated withGuy’s and St Thomas’ NHS Foundation Trust
    • , Amit BahlAffiliated withBristol Haematology and Oncology Centre

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As recently as 2004, treatment options for men with metastatic castration-resistant prostate cancer (mCRPC) were limited, with docetaxel the only approved agent conferring a survival benefit. The therapeutic landscape is now very different, with several agents demonstrating prolonged survival since 2010. New agents for the treatment of mCRPC include sipuleucel-T, cabazitaxel, abiraterone acetate, enzalutamide and radium-223. All are now approved for use in this patient group, although the specific licensing terms vary between agents. In addition, denosumab may have utility in patients with bone metastases. A number of novel agents are also in development with promising initial results. However, because these treatment options have proliferated rapidly, there is currently a paucity of clinical evidence regarding their optimal sequencing. Selection of an appropriate treatment option should take into consideration disease characteristics, drug availability and patient choice. In summary, we discuss several new treatment options available for mCRPC and their integration into the current treatment paradigm.


Abiraterone acetate Cabazitaxel Enzalutamide Radium-223 Metastatic castration-resistant prostate cancer Oncology Sipuleucel-T Treatment sequencing