Metastatic castrate-resistant prostate cancer: dawn of a new age of management

With current and forthcoming developments in the treatment of metastatic castrate-resistant prostate cancer (mCRPC) post-docetaxel, we are embarking on an age of potential 'chronic' management of this disease. It is hoped that the survival benefits associated with the various treatments, cytotoxic, hormonal and immunotherapeutic, will prove to be additive, providing a multimodal continuum of care. If so, it will be necessary to determine the optimal sequence and timing of the new treatments. One key factor in this regard is likely to be the patient's performance status and hence his eligibility for cytotoxic intervention. If chemotherapy is offered early in the post-docetaxel pathway, the patient may still be able to benefit from non-chemotherapeutic options subsequently. However, if this stage of management begins with a non-chemotherapeutic option, there is a risk that the patient's performance status will decline before he has an opportunity to benefit from chemotherapy. Further studies and ongoing clinical experience are likely to clarify this important issue, and help clinicians to maximise the survival of men with mCRPC post-docetaxel.