Open Access

REVIEW

New treatment options for castrate-resistant prostate cancer: a urology perspective

Leonard G. Gomella, Francisco Gelpi, William Kevin Kelly

Departments of Urology and Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. Leonard G. Gomella, Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Room 1102, Philadelphia, PA 19107 USA

Canadian Journal of Urology 2011, 18(4), 5767-5777.

Abstract

Introduction: Castrate-resistant prostate cancer (CRPC) is the most clinically advanced form of prostate cancer. Prior to 2004, treatment options for patients with CRPC were limited to palliative care with mitoxantrone. However, two phase III trials in 2004 showed improved survival with docetaxel compared with mitoxantrone in patients with metastatic CRPC. Docetaxel remains the current standard chemotherapy for CRPC.
Materials and methods: A literature review was conducted to ascertain agents recently approved or in development for CRPC as well as several treatment algorithms being developed in this patient population.
Results: Recently, the US Food and Drug Administration (FDA) approved chemotherapy agents including cabazitaxel, a novel taxane, for the treatment of patients with metastatic CRPC who were previously treated with docetaxel-based chemotherapy. The immunotherapy sipuleucel-T and the androgen biosynthesis inhibitor, abiraterone, have also just been approved. A number of other novel agents are in clinical development for the management of CRPC.
Conclusions: Options for the management of CRPC are rapidly expanding. Based on improved survival with docetaxel in patients with CRPC, chemotherapy is being investigated for use earlier in the prostate cancer disease spectrum. Studies are actively evaluating chemotherapy in the neoadjuvant and adjuvant settings for patients with high risk, localized prostate cancer. A multidisciplinary approach towards patients with difficult-to-manage prostate cancer in which urologists familiarize themselves with these newer systemic agents and refer appropriate patients to oncologists may be beneficial.

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