title: Therapeutic options and multifaceted treatment paradigms in metastatic castrate-resistant prostate cancer.
abstract: OBJECTIVE
  The field of prostate cancer therapeutics has undergone a rapid and dramatic change in the last few years. Multiple agents with very distinct mechanisms of actions and unique toxicities and efficacies have become available for clinical use. The focus of this review is to give a summary of clinical perspectives of the indications, including pros and cons of the currently approved regimens. The next generation of novel targets and agents is also highlighted.
  
  
  RESULTS
  Addition of docetaxel-based chemotherapy to conventional androgen suppression therapy in hormone sensitive advanced prostate cancer demonstrated overall survival benefit in recently released results of ECOG 3805. In castrate-resistant metastatic disease, development of novel immunotherapy (Sipuleucel T), chemotherapy (docetaxel and cabazitaxel), radiation (alpharadin) and hormone therapy (abiraterone and enzalutamide) agents has created a range of choices for treatment, palliation and improved life expectancy.
  
  
  CONCLUSIONS
  A paradigm shift has occurred in the management of advanced prostate cancer, with multiple novel agents addressing distinct pathways, and demonstrating powerful efficacy. The judicious use of the available agents, with finesse of sequencing, and concomitant palliative care has prolonged survival and made living with the disease more reasonable and tolerable.
authors.affiliation: Karmanos Cancer Institute/Wayne State University, Detroit, Michigan, USA.
authors.forename: Ulka
authors.initials: U
authors.lastname: Vaishampayan
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D010166:Palliative Care / Q000379:methods; D064129:Prostatic Neoplasms, Castration-Resistant / Q000473:pathology / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004791:Enzyme Inhibitors; D047428:Protein Kinase Inhibitors