How to approach sequencing therapy in patients with metastatic castration resistant prostate cancer.

Background: Rapid progress has recently been made in understanding the biology of advanced prostate cancer. This has translated into the development of a number of novel agents to treat metastatic castration resistant prostate cancer (mCRPC).

Methods: The relevant literature was retrieved from a search of MEDLINE with appropriate key words.

Results: Therapeutic approaches to mCRPC include chemotherapy, hormonal manipulation, immunotherapy and radioisotope therapy. Docetaxel and cabazitaxel are cytotoxic agents which have demonstrated a modest impact on survival. Hormonal manipulation with abiraterone and enzalutamide have also been reported to be beneficial in mCRPC. The radioisotope radium 223 utilizes a novel approach in treating mCRPC and was recently described in a positive phase III trial. Finally, sipuleucel-T is an immunotherapy that has a demonstrated overall survival benefit in mCRPC.

Conclusions: A number of phase III trials have been published that describe agents which are beneficial in treating mCRPC. Future research will focus on sequencing these agents in a clinically rational and economically viable manner.