Metastasized castration-resistant prostate cancer (mCRPC) is defined by disease progression despite androgen depletion therapy (ADT). While until recently a life-prolonging effect could only be demonstrated for the taxane docetaxel, various alternative therapeutic options based on different mechanisms of action are available today: CYP17-inhibitor abiraterone and antiandrogen enzalutamide target the androgen receptor-signaling pathway, which maintains a crucial role in mCRPC. Cabazitxel - a semisynthetic taxane derivate - is the only second line chemotherapy, which results in a prolongation of overall survival to date. Alpha emitter Radium-223 has the ability to mimic calcium and target bone metastases. Thus, it is a reasonable therapeutic alternative for patients suffering from symptomatic bone metastases. In 2013, Sipuleucel-T was the first immunotherapy approved for CRPC in Europe. In this review we introduce the different therapeutic options to the reader, reflect the possible therapeutic sequences and give a perspective on novel pipeline medications.
