, Volume 79, Issue 4, pp 381–400 | Cite as

The Evolving Systemic Treatment Landscape for Patients with Advanced Prostate Cancer

  • Martina Pagliuca
  • Carlo Buonerba
  • Karim Fizazi
  • Giuseppe Di LorenzoEmail author
Review Article


Prostate cancer (PC) is a major health issue in developed countries, with, on the one hand, men suffering from sequelae related to unnecessary treatment of non-lethal PC, and, on the other hand, still dying because of advanced PC that progresses to castration-resistant disease. Systemic treatment is the mainstay of therapy of castration-resistant PC (CRPC). To date, a multitude of systemic agents have been tested and many of these have failed to provide a clinically meaningful benefit in CRPC, while others have been approved by the US Food and Drug Administration and/or the European Medicines Agency, including antiandrogen hormonal drugs (abiraterone, enzalutamide, apalutamide), chemotherapy (docetaxel and cabazitaxel), immunotherapy (Sipuleucel-T), and radiopharmaceutical (Radium-223) agents. In this review, systemic treatments regarded as most likely to have an impact in clinical practice are presented and discussed. In addition to the pivotal clinical studies, selected retrospective and non-randomized clinical trials are also discussed if deemed to have an impact on clinical practice or future research. A comprehensive appraisal of the expanding landscape of systemic therapies for advanced PC is provided from an expert perspective, with a focus on novel classification and diagnostic tools that have been paving the way for the development of precision medicine in PC.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflict of Interest

Dr. Pagliuca has no discloses to declare. Dr. Buonerba reports receiving research grants to his institution from Sanofi, Astellas, Quercegen Pharmaceuticals, and AstraZeneca; and consulting and travel expenses from Sanofi. Prof. Fizazi reports receiving consulting fees or honorarium from AstraZeneca, Janssen, Astellas, Sanofi, Orion, CureVac, Novartis, Bayer, and Amgen; support for travel to meetings for the study, manuscript preparation, or other purposes from Amgen and Janssen; and payment for lectures, including service on speakers’ bureaus, from Janssen. Dr. Di Lorenzo reports receiving research grants to his institution from Sanofi, Astellas, Quercegen Pharmaceuticals, and AstraZeneca; and consulting fees and travel expenses from Sanofi.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Martina Pagliuca
    • 1
  • Carlo Buonerba
    • 1
    • 2
  • Karim Fizazi
    • 3
  • Giuseppe Di Lorenzo
    • 1
    • 4
    Email author
  1. 1.Department of Clinical Medicine and SurgeryUniversity Federico II of NaplesNaplesItaly
  2. 2.Experimental Zoo-prophylactic Institute of Southern ItalyPorticiItaly
  3. 3.Institut Gustave Roussy, University of Paris SudVillejuifFrance
  4. 4.Department of MedicineUniversità degli Studi del MoliseCampobassoItaly

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