PURPOSE OF REVIEW: Prior to 2010, docetaxel was the only treatment shown to 
prolong survival in metastatic castrate-resistant prostate cancer (CRPC). In the 
past 3 years, several therapeutic agents have demonstrated survival improvements 
for CRPC after the receipt of prior docetaxel, leading to multiple approvals by 
the US Food and Drug Administration.
RECENT FINDINGS: The development of these novel agents, each with a distinct 
mechanism of action, is the fruition of sedulous preclinical research and well 
designed clinical trials. Cabazitaxel, a next generation taxane, was the first 
Food and Drug Administration-approved drug for the postdocetaxel setting. The 
recognition of sustained androgen dependence of CRPC has led to the 
identification of more potent and selective inhibitors of androgen synthesis and 
androgen-receptor signaling, such as abiraterone and enzalutamide, respectively. 
Radium-223, an α-emitting radionuclide still under regulatory review, recently 
showed a significant survival benefit for CRPC. Finally, sipuleucel-T, a form of 
immunotherapy, may benefit a subset of patients in the postdocetaxel setting.
SUMMARY: Post-docetaxel management of CRPC has undergone a dramatic yet welcome 
paradigm change in the past 3 years. With multiple life-prolonging agents 
available, it now becomes imperative to coordinate how and when these new 
therapies should be used and sequenced to achieve optimal patient outcomes.