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Today, the picture is vastly different: several additional therapies have each demonstrated a survival benefit such that we now have chemotherapy (cabazitaxel), androgen suppressive agents (abiraterone acetate and enzalutamide), a cellular vaccine (sipuleucel\u2010<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>) and radium\u2010233 (for symptomatic bone metastases). With several other agents in the pipeline for late\u2010stage disease, the future looks promising for <jats:styled-content style=\"fixed-case\">mCRPC<\/jats:styled-content>. As the available data are not able to inform as to the optimum sequencing of therapy, this remains a challenge. This paper draws on insights from published and ongoing clinical studies to provide a practical patient\u2010focused approach to maximize the benefits of the current therapeutic armamentarium. Preliminary sequencing suggestions are made based on clinical trial criteria. But until more data become available, clinical gestalt, experience, cost and individual patient preferences will continue to drive choices.<\/jats:p>","DOI":"10.1111\/ajco.12193","type":"journal-article","created":{"date-parts":[[2014,4,3]],"date-time":"2014-04-03T07:15:09Z","timestamp":1396509309000},"page":"205-215","source":"Crossref","is-referenced-by-count":3,"title":["Challenges in the sequencing of therapies for the management of metastatic castration\u2010resistant prostate cancer"],"prefix":"10.1111","volume":"10","author":[{"given":"Phillip","family":"Parente","sequence":"first","affiliation":[{"name":"Medical Oncology Box Hill Hospital  Box Hill Victoria Australia"},{"name":"Faculty of Medicine Monash University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Parnis","sequence":"additional","affiliation":[{"name":"Adelaide Cancer Centre  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Gurney","sequence":"additional","affiliation":[{"name":"Clinical Research Medical Oncology Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,4,3]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Cancer Incidence Projections: Australia, 2011 to 2020","author":"Australian Institute of Health and Welfare","year":"2012"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.4065\/82.2.243"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041318"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040720"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1001294"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61389-X"},{"issue":"8","key":"e_1_2_7_8_1","first-page":"272","article-title":"Cabazitaxel plus prednisone\/prednisolone significantly increases overall survival compared to mitoxantrone plus prednisone\/prednisolone in patients with metastatic castration\u2010resistant prostate cancer (mCRPC) previously treated with docetaxel: final results with updated overall survival of a multinational phase iii trial (TROPIC)","volume":"21","author":"Oudard S","year":"2010","journal-title":"Ann Oncol"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70379-0"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1207506"},{"issue":"18","key":"e_1_2_7_11_1","article-title":"Updated analysis of the phase III, double\u2010blind, randomized, multinational study of radium\u2010223 chloride in castration\u2010resistant prostate cancer (CRPC) patients with bone metastases (ALSYMPCA)","volume":"30","author":"Parker C","year":"2012","journal-title":"J Clin Oncol"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209096"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-7563.2011.01506.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr514"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djs279"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2013.01.061"},{"key":"e_1_2_7_17_1","unstructured":"NIH Clinical Trials Database.Study NCT01254279: early access to cabazitaxel in patients with metastatic hormone refractory prostate cancer previously treated with a docetaxel\u2010containing regimen.2011. 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