Table 1.

Summary of agents demonstrating an overall survival advantage in phase III trials in metastatic castration-resistant prostate cancer.

Treatment	Comments
Docetaxel and prednisone	FDA-approved in 2004, this regimen is most likely to bring symptomatic relief for patients with metastatic disease. In spite of its therapeutic benefits, many patients are reluctant to receive this regimen because its side effects are more severe than those of hormonal therapies.
Sipuleucel-T	FDA-approved in 2010, this first-in-class therapeutic cancer vaccine has demonstrated an overall survival advantage relative to placebo in patients with minimally symptomatic disease. Its brief course of therapy (3 infusions over 1 month) and minimal side effect profile make it appealing. Issues restricting use include initial limited availability and lack of intermediate biomarkers indicative of clinical benefit.
Cabazitaxel and prednisone	FDA-approved in 2010, this was the first regimen to demonstrate an overall survival advantage in metastatic prostate cancer patients who progressed on docetaxel-based therapies. Its side effect profile, including significant myelosuppression, may limit its utility in chemorefractory patients. Residual side effects include marrow toxicity.
Abiraterone	In late 2010, this CYP-17 lyase inhibitor demonstrated overall survival benefits in patients with metastatic disease who had already been treated with chemotherapy. Its side effect profile is favorable relative to chemotherapy. Ongoing studies are evaluating this agent in chemotherapy-naïve patients with metastatic prostate cancer.