This section highlights the current cytotoxic management of prostate cancer. Although cytotoxic treatment agents for prostate cancer have not changed much over the years, new treatment modalities, targeted therapies and imaging advances have led to new approaches to cytotoxic treatment options. Another important consideration when prescribing treatment is the balance between potential side effects and treatment response. Measures of patient quality of life and performance status can guide clinicians in this regard. Overall, future therapies in the systemic treatment of prostate cancer will focus on combination therapies.