Purpose: Our previous work has shown that methylseleninic acid (MSeA) sensitized hormone refractory prostate cancer (HRPCa) cells to apoptosis induced by paclitaxel (Taxol) through enhancing multiple caspases. This study aimed to (a) determine the general applicability of the sensitization effect for taxane drugs in vitro, (b) establish the enhancement of paclitaxel efficacy by MSeA in vivo, and (c) investigate Bcl-XL and survivin as molecular targets of MSeA to augment apoptosis. Experimental design: DU145 and PC-3 HRPCa cell lines were used to evaluate the in vitro apoptosis effects of paclitaxel, docetaxel and their combination with MSeA, and the molecular mechanisms. DU145 xenograft growth in athymic nude mice was used to evaluate the in vivo efficacy of paclitaxel and its combination with MSeA. The tumor samples were used to examine Bcl-XL and survivin protein abundance. Results: MSeA combination with paclitaxel or docetaxel exerted a greater than additive apoptosis effect on DU145 and PC-3 cells. In nude mice, paclitaxel and MSeA combination inhibited growth of DU145 subcutaneous xenograft with the equivalent efficacy of a four-time higher dose of paclitaxel alone. MSeA decreased the basal and paclitaxel-induced expression of Bcl-XL and survivin in vitro and in vivo. Ectopic expression of Bcl-XL or survivin attenuated MSeA/paclitaxelinduced apoptosis. Conclusions: MSeA enhanced the efficacy of paclitaxel against HRPCa in vitro and in vivo, at least in part, by down-regulating the basal and paclitaxel-induced expression of both Bcl-XL and survivin to increase caspase-mediated apoptosis. MSeA may be a novel agent to improve taxane combination therapy.Prostate cancer is a serious threat to the health and quality of life of American men and is the second leading cause of cancerrelated death. Improvement in the efficacy of chemotherapy is urgently needed for patients with metastatic hormone refractory prostate cancer (HRPCa; ref. 1). The taxane drug docetaxel is the only Food and Drug Administration -approved chemotherapeutic agent for clinical treatment of advanced HRPCa. Two landmark studies (refs. 2,3; Southwest Oncology Group 9916 and TAX 327) provided the key support for this indication by demonstrating a modest survival advantage in HRPCa patients by using docetaxel-based combination chemotherapy.These studies supported taxane-based therapy as an attractive platform to develop new combinational regimens, which remain a high priority for many ongoing studies. A better understanding of the mechanisms of taxane resistance could provide a more rational strategy for the development of more effective taxane-based therapeutic combinations.Taxane drugs disrupt microtubule dynamics through direct binding to the h-subunit of tubulin, leading to mitotic arrest and eventual apoptosis (4). Taxanes are susceptible to several mechanisms of drug resistance. The first is the classic multidrug resistance gene product P-glycoprotein to pump the drugs out of the cells (5). The second is related to microtubule alte...