Chemotherapy and targeted therapies: are we making progress in castrate-resistant prostate cancer?

First-line therapy for men with metastatic or recurrent prostate cancer following definitive local therapy is medical or surgical castration. Though effective initially in most patients, the majority of tumors develop castration resistance, necessitating the addition of further therapy. The historic treatment paradigm of second-line androgen manipulation, followed by cytotoxic salvage chemotherapy, has changed in recent years with better understanding of mechanisms that lead to castration resistance. This review will outline the data supporting the use of targeted and chemotherapeutic agents for prostate cancer, review data leading to US Food and Drug Administration (FDA) approval of the newest agents abiraterone, enzalutamide, and cabazitaxel, as well as review ongoing studies of novel agents.