Where Does Chemotherapy Fit into Prostate Cancer Treatment?

The treatment of metastatic castrate-resistant prostate cancer has changed dramatically in recent years. Several agents have been shown to improve survival in men with castrate-resistant prostate cancer after docetaxel and, for abiraterone acetate and enzalutamide, in chemotherapy-naïve castrate-resistant prostate cancer patients also. These two drugs are now approved and reimbursed in Australia for use in castrate-resistant prostate cancer after docetaxel, or in men unsuitable to receive chemotherapy. It is reasonable to hypothesise that use of these novel survival-prolonging therapies earlier in the treatment course might improve outcomes and this hypothesis is currently being tested in clinical trials. Cytotoxic chemotherapy is often seen as a less desirable treatment strategy and perhaps some men with castrate-resistant prostate cancer are no longer being considered for this treatment. This perception might also lead to changes in management and prescribing practices, including a shift away from multidisciplinary decision-making. However, a careful review of the available literature suggests that this strategy might not be in the best long-term interests of these men and that cytotoxic chemotherapy, rather than being
undesirable, might instead be best used as first line management in men able to receive it.