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Chemotherapy in castration-resistant prostate cancer

Arif Hussain, MD
Nancy A Dawson, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


For men with advanced prostate cancer, androgen deprivation therapy usually can provide disease control for a substantial period of time. However, the vast majority of men eventually develop progressive disease that is resistant to further hormonal treatment.

Prior to the development of the taxanes, cytotoxic chemotherapy was considered to be relatively ineffective in men with castration-resistant prostate cancer. In early trials, objective response rates were 10 to 20 percent, and median survival generally did not exceed 12 months.

However, taxane-based regimens have been associated with higher rates of objective tumor regression and biochemical (prostate-specific antigen [PSA]) response, as well as longer overall survival. As discussed below, docetaxel has an established role in chemotherapy-naive patients, and a second-generation taxane, cabazitaxel, is active in patients who have received prior docetaxel.

The use of cytotoxic chemotherapy for the treatment of castration-resistant prostate cancer will be reviewed here. The use of chemotherapy in combination with androgen deprivation therapy for castration-sensitive disease is discussed separately, as are experimental approaches. (See "Overview of the treatment of disseminated castration-sensitive prostate cancer" and "Investigational approaches for the treatment of advanced prostate cancer".)


For patients with castration-resistant prostate cancer who have not received prior chemotherapy, docetaxel given every three weeks in conjunction with prednisone remains the preferred approach to systemic chemotherapy. (See "Treatment protocols for castration-resistant prostate cancer", section on 'Docetaxel and prednisone'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 28, 2017.
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