Landmarks in non-hormonal pharmacological therapies for castration-resistant prostate cancer

The treatment of metastatic and castration-resistant prostate cancer (CRPC) has advanced considerably from the era where it was considered that the disease was resistant to chemotherapy. Cytotoxic chemotherapy involving docetaxel is now used routinely as a first-line therapy after failed first-and second-line androgen deprivation in advanced disease, improving quality of life and to a limited extent, survival in patients with advanced prostate cancer. The cytotoxic taxane, cabazitaxel has also become a second-line treatment option for patients with CRPC failing previous docetaxel therapy. Additionally, a broad range of agents are now available or under development including immune-based therapies (cellular therapies and vaccines), bone-targeting agents (anti-osteolytic and anti-tumour therapies) and molecular-based agents targeting cellular control mechanisms. Most of these remain experimental but on-going pharmacological development will inevitably provide urologists and urological oncologists with a broader range of therapeutic options for better cancer management in the future.