Docetaxel in the treatment of castrate resistant advanced prostate cancer: a paradigm in change

Until last year, the international guidelines recommended the use of docetaxel in advanced prostate cancer (PC) at the time of progression following androgen deprivation therapy (ADT). Nevertheless, two randomized phase III trials, CHAARTED and STAMPEDE, delivered level I evidence showing that upfront introduction of docetaxel, during the androgen sensitive course of disease, is able to significantly improve the patients' overall survival. As such, this strategy was rapidly included in the current guideline recommendations, with slightly different indications in the ESMO as compared to the NCCN version. Side effects of chemotherapy along with the possible higher benefit in high vs low-volume metastatic disease should be taken into consideration when choosing this alternative. The present paper makes a review of the current data supporting the new indication of docetaxel, and provides detailed information in order to assist the clinician in deciding the best treatment for patients with advanced PC.