Systemic treatment for metastatic castration-resistant prostate cancer (mCRPC) is rapidly evolving with several drugs approved in recent years. The utility of immunotherapy, chemotherapy, novel anti-androgen and androgen-targeted signaling agents for this particular patient population has been well-established . This article discusses the pivotal trials that led to the approval of these drugs as well as a proposed algorithm in the care of patients with mCRPC.
In addition to denosumab for suitable men with bone involvement , androgen deprivation therapy (ADT) in the form of degarelix has been utilized, which is non-inferior to leuprolide in all comers with metastatic prostate cancer . Following inevitable rise in PSA, chemotherapy with docetaxel  followed by cabazitaxel  is largely reserved for fit, symptomatic patients, while anti-androgen agents including abiraterone acetate with prednisone , enzalutamide , and radium-223  should all be considered well-tolerated and effective treatments. Management prolonging survival also includes the autologous dendritic cell vaccine, sipuleucel-T  although no significant prostate specific antigen (PSA) responses have been seen. Novel prospects on the horizon for this ultimately fatal condition also include an androgen receptor antagonist, ARN-509 , and the dual MET and VEGF receptor inhibitor, cabozantinib  and , although the latter has shown preliminary negative updated results.
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Manish Pant, M.D. and Jeanny B. Aragon-Ching, M.D., F.A.C.P.
Division of Hematology/Oncology, Department of Medicine, George Washington University Medical Center