Docetaxel

Despite the widespread use of prostate-specific antigen (PSA) for prostate cancer screening, many patients still present with or develop evidence of progressive, metastatic, or recurrent disease. First-line treatment for these patients has long been androgen deprivation therapy (ADT). Initial ADT usually consists of medical or surgical castration, but these agents fail in a median of 18-24 months, as patients develop castration-resistant prostate cancer (CRPC). Treatment options at this point in disease progression traditionally provided palliation only. Secondary hormonal manipulations can produce PSA responses, and the standard chemotherapy combination of mitoxantrone and prednisone can ameliorate symptoms but neither approach ever produced better survival than prednisone alone. Docetaxel-based chemotherapy is the first treatment regimen demonstrated to increase survival in patients with CRPC. The exact timing of treatment in the spectrum of CRPC and duration of docetaxel therapy remains controversial. This chapter reviews the use of docetaxel in prostate cancer, discusses the optimal timing of chemotherapy, and highlights the future directions in taxane-combination therapy involving novel investigational uses.