Table 2.

Predicted Castration-Resistant Prostate Cancer Treatment Dilemmas for Physicians in 2012

Treatment dilemmaPossible answer
What is the frequency of cross-resistance between abiraterone acetate and MDV3100, and is there a benefit in sequential use?Requires formal evaluation in postregulatory studies.
How does one decide whether to use abiraterone acetate or MDV3100 first?Biomarkers that identify resistance to specific agents are required. Sequence will probably be initially defined by local guidelines.
Are abiraterone acetate or MDV3100 best used before docetaxel, and is there a patient subgroup that should be offered chemotherapy before either agent?Better toxicity profile of hormonal treatments may lead to their use before chemotherapy.
How does one select patients for cabazitaxel in preference to abiraterone acetate or MDV3100 after treatment with docetaxel?Better toxicity profile of hormonal treatments may lead to their use before cabazitaxel, although most patients will be expected to receive all approved treatments through the course of management of their disease.
How does one coordinate treatment with Sipuleucel-T with initiation of treatment with abiraterone acetate or MDV3100?No data available.
Should abiraterone acetate be continued or stopped at disease progression?No data available.