Metastatic prostate cancer: what's new since docetaxel?

Docetaxel is the standard first line treatment in metastatic castration-resistant prostate cancer. The time to begin docetaxel remains questionable. Regarding conventional therapy, the old cytotoxic agent estramustine is still controversial, but data suggest a survival advantage when combined with docetaxel. This therapeutic improvement has resulted in the clinical development of several new agents, some as monotherapy, others in combination with docetaxel, as first or second line treatment. Numerous clinical trials have improved the comprehension of the disease continuum, generating new recommendations, especially concerning outcome measures. Two new drugs are being tested: the satraplatin and the ixabepilone. The principle of targeting bone metastasis has induced new options of treatment, such as targeting RANK-ligand, systemic radioisotopes, or the inhibition of the endothelin 1 receptor A. Antiangiogenic agents are also tested in clinical trials, especially bevacizumab, VEGF-trap and vandetanib. Furthermore, hormone manipulations appear promising, especially abiraterone acetate and the antagonists of the androgen receptor.