In the phase III TROPIC trial, cabazitaxel in combination with prednisone was compared to mitoxantrone with prednisone in patients with metastatic castration-resistant disease (mCRPC) that had received previous therapy with docetaxel. Cabazitaxel therapy was associated with an improvement in overall survival (the primary endpoint of the study), leading to its FDA approval for use in this setting. Although cabazitaxel was the first agent approved in the post-docetaxel space, several other agents have entered (or are probably soon to enter) the therapeutic armamentarium, including abiraterone, MDV3100, and radium-223. As such, the oncologist is faced with the issue of balancing the risks and benefits of diverse therapies in this setting in the absence of comparative data. Although the difficulties associated with cytotoxic therapy may cause both the patient and physician to delay use of cabazitaxel after docetaxel, we present a case to illustrate that the agent can be well tolerated and efficacious even in the very elderly. Our patient, an octogenarian with mCRPC and evidence of progression after 10 cycles of docetaxel, has tolerated 24 cycles of cabazitaxel to date with disease stabilization and minimal toxicity. Herein, we discuss considerations in selecting appropriate post-docetaxel therapies in an increasingly complex therapeutic landscape.