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Summary of key data and guideline recommendations
Decision makers for the treatment of metastatic castration resistant prostate cancer (mCRPC) are according to the recommendations of European Association of Urology (EAU) 2016 based on performance status of the patient and asymptomatic or symptomatic disease. Second line treatment of patients with no or mild symptoms and no visceral metastases would be with docetaxel, abiraterone, enzalutamide, cabazitaxel or radium-223. Professor Peter FA Mulders, Radboud University Medical Center, Nijmegen, presents the COU-AA-302 study and its subgroup analysis with abiraterone and prednisolone and the PREVAIL trial with enzalutamide both demonstrating a significantly improved outcome in patients with mCRPC. He further emphasizes the need for prospective randomized trials to investigate the best sequence and combination of agents and to understand the mechanisms of cross-resistance.