Maximizing Survival in Metastatic Castrate-resistant Prostate Cancer

A Clinical Viewpoint

Alison Birtle


Expert Rev Anticancer Ther. 2013;13(1):89-99. 

In This Article

Abstract and Introduction


Recently, licensed and emerging treatments for metastatic castrate-resistant prostate cancer are transforming the prognosis for men whose disease has already progressed during or after docetaxel-based chemotherapy. Two agents (cabazitaxel and abiraterone) are already accessible to prescribers, having shown survival benefits versus their comparators in randomized controlled trials, and other agents are showing promising results. A future in which metastatic castrate-resistant prostate cancer can be managed as a 'chronic disease' looks tantalizingly close. The challenge for clinicians will be to use these treatments rationally, in a way that optimizes each individual patient's chances of prolonged survival.


Prostate cancer remains the most commonly diagnosed malignancy in men, with more than 40,000 new cases each year in the UK.[101] It is estimated that approximately 22% of patients have locally advanced or metastatic disease at presentation.[1]

Growth and replication of prostate cells is dependent on androgens. Hence, the mainstay of treatment for metastatic prostate cancer is initially hormonal therapy, typically using a luteinizing hormone-releasing hormone (LHRH) agonist followed by other hormonal agents, culminating in combined androgen blockade.[2,3] While such 'medical castration' can slow disease progression and alleviate symptoms, most patients eventually develop hormone-refractory disease, that is, their cancer progresses despite hormonal intervention.[2] This stage of the disease is known as metastatic castrate-resistant prostate cancer (mCRPC), although earlier literature often uses the term metastatic hormone-refractory prostate cancer.

For many years, mCRPC was considered to confer a terminal prognosis, with a median survival of 12 months from development of castrate resistance.[2] However, the advent of several new agents has improved both the prognosis and quality of life for men with this illness. Indeed, mCRPC can now be considered as a chronic illness, for which the focus of treatment should be to enable patients to live as near-normal a life as possible with a view to maximize survival as well. This article provides an overview of developments in advanced prostate cancer and considers how the available options for lengthening survival for men with mCRPC may be sequenced.