Metastatic castrate-resistant prostate cancer: New landscape, new challenges

Just 5 years after docetaxel was recommended by the National Institute for Health and Clinical Excellence as the standard of care for metastatic castrate-resistant prostate cancer, a novel taxane-cabazitaxel-has been licensed in Europe and the USA for a similar indication. It is authorised for use in patients whose disease progresses after docetaxel, for whom it has been shown to provide a survival benefit over current palliative strategies. However, it is not the only new treatment for this population of patients. The hormonal agent abiraterone has also been licensed in the USA, and is expected to receive a European licence later this year, the sipuleucel-T vaccine has been approved in the USA, and other agents are on the near horizon. While these advances are undoubtedly welcome, much thought will need to be given to their optimal use in terms of patient selection, the timing/sequencing of treatment, and to the design of the prostate cancer treatment paradigm. It will also be important to consider the impact that new agents will have on healthcare spending and capacity. (C) 2011 Published by Elsevier Ltd on behalf of British Association of Urological Surgeons.