New Treatment Options for Patients With Metastatic Prostate Cancer: What Is The Optimal Sequence?

Systemic treatment of men with metastatic prostate cancer is rapidly evolving. Androgen deprivation therapy remains the first-line treatment for advanced disease and the backbone of sequential strategies. For patients with extensive metastatic disease the addition of docetaxel markedly improves survival. In case patients develop castration-resistant prostate cancer, several new therapeutic strategies are available. Large trials have shown a survival benefit for patients treated with sipuleucel-T, docetaxel, cabazitaxel, abiraterone, enzalutamide, or radium-223. Along with these new available treatment options, the sequence of applying them has become a serious matter of debate. In this review we provide an overview of current systemic treatment options for metastatic prostate cancer and propose considerations to optimally sequence registered new therapies. In addition, we hypothesize on improvement of outcome with potential combination strategies.