Systemic Chemotherapy in Metastatic Castration-Resistant Prostate Cancer

Abstract

Prostate cancer is the second mortality cause among males with cancer. Patients with metastatic castration resistant prostate cancer (mCRPC) essentially die due to tumor progression in a castration resistance situation. Docetaxel based chemotherapy was the first therapeutic strategy that demonstrated a survival increase, in addition to pain decrease, increase in tumor responses and quality of life benefit, and it currently continues being useful after the incorporation of new therapies for the treatment of mCRPC. Cabazitaxel, a taxane with efficacy in docetaxel resistant tumors, was the second drug demonstrating increased survival in this scenario, and it is an additional alternative option effective in selected patients. Patients with aggressive variants and those with DNA repair genes alterations may benefit from platin-based therapies. In the absence of validated biomarkers, we should base our decisions on clinical and patient's preferences criteria. It is important to design a comprehensive therapeutic plan at an early stage including the treatments with demonstrated efficacy on survival. For this, it is essential a comprehensive and multidisciplinary evaluation of the patient at the start of therapy and during tumor evolution. This evaluation must be done with an adequate information process and shared decision together with the patient.