Future directions in non-endocrine systemic treatment of metastatic prostate cancer

The management of prostate cancer that has become resistant to androgen deprivation is becoming more complex. Chemotherapy using docetaxel is now an established therapy for such patients with metastatic disease. Other agents including the epothilones are being evaluated and combination regimens have shown significant activity in the phase 2 setting. Other approaches for instance bisphosphonates and small molecule targeted agents are being investigated although their place in therapy is still to be determined. The use of hormones post-chemotherapy may also be useful for a subset of patients. Determining endpoints in phase 2 studies remain a problem as PSA on its own may be unreliable – new guidelines for reporting such studies have just been released which should allow some standardisation in approach. Combining various approaches is likely to depend on the pattern and speed of progression following failure of androgen deprivation.