In 2015, my choice remains docetaxel.ĭocetaxel: Impact on Pain and Quality of Life In this context, clinicians who are managing patients who have mCRPC with symptomatic progression while taking abiraterone acetate (Zytiga, Janssen Biotech) and/or enzalutamide (Xtandi, Astellas/Medivation) are increasingly challenged to decide between radium-223 (Xofigo, Bayer/Algeta) and docetaxel as the next systemic therapy, assuming that the patients have bone metastases and other disease findings appropriate for radium-223. Physicians managing advanced prostate cancer are well aware of the significant bone tropism of the disease, and the long history of effective symptomatic management of metastatic bone pain with external beam radiotherapy. One of the key decision points in the management of patients with mCRPC is the presence or absence of disease-related symptoms, the most common of which are pain, progressive fatigue, and anorexia. Given the rapid introduction of novel agents into the therapeutic armamentarium, our current inability to define the optimal therapeutic paradigm for patients with mCRPC is understandable. The management of metastatic castration-resistant prostate cancer (mCRPC) has evolved rapidly over the past several years, with the unprecedented approval of 5 new therapeutic agents. Robert Dreicer, MD, MS, is the section head of medical oncology and the deputy director and associate director for clinical research at the University of Virginia Cancer Center, and a professor of medicine and urology at the University of Virginia School of Medicine in Charlottesville, Virginia. What should the next step be for men with metastatic castration-resistant prostate cancer? According to Dr Robert Dreicer, the answer is docetaxel, whereas Drs Jing Li and Andrew Armstrong maintain that radium-223 should be used prior to docetaxel.ĭocetaxel Still the Optimal First Choice for Symptomatic Metastatic Castration-Resistant Prostate Cancer It is not unusual for metastatic prostate cancer to progress despite treatment with abiraterone acetate, enzalutamide, or both. Clinical Advances in Hematology & Oncology

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