Chemotherapy is sometimes used if prostate cancer has spread outside of the prostate gland and hormone therapy isn't working. It is not a standard treatment for early prostate cancer, but some studies are looking to see if chemotherapy could be helpful if given for a short time after surgery.
Chemotherapy uses anti-cancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment potentially useful for cancers that have spread (metastasized) to distant organs.
At one time, chemotherapy was not thought to be very effective in treating prostate cancer, but this has changed in recent years. A combination of the chemotherapy drug docetaxel (Taxotere®) and the steroid drug prednisone has been shown to reduce symptoms and prolong life for an average of about 3 months (when compared with other chemotherapy drugs) in patients with advanced prostate cancer. Most doctors now consider this to be the first-line chemotherapy option in men whose cancer is no longer responding to hormonal treatments. Recently, a new drug called cabazitaxel (Jevtana®) was approved for use in men with advanced prostate cancer. When given to men whose cancers stopped responding to docetaxel, it helped them live longer.
Some of the other chemotherapy drugs used to treat prostate cancer include:
- Mitoxantrone (Novantrone®)
- Estramustine (Emcyt®)
- Doxorubicin (Adriamycin®)
- Etoposide (VP-16)
- Vinblastine (Velban®)
- Paclitaxel (Taxol®)
- Carboplatin (Paraplatin®)
- Vinorelbine (Navelbine®)
Like hormone therapy, chemotherapy is unlikely to result in a cure. This treatment is not expected to destroy all the cancer cells, but it may slow the cancer's growth and reduce symptoms, resulting in a better quality of life.
Possible side effects of chemotherapy
Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects may include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Lowered resistance to infection (due to low white blood cell counts)
- Easy bruising or bleeding (due to low blood platelets)
- Fatigue (due to low red blood cells)
In addition, each chemotherapy drug may have its own unique side effects. For example, estramustine, a drug sometimes used to treat prostate cancer, also carries the risk of blood clots. Docetaxel can cause severe allergic reactions. Medication is given before docetaxel treatments to prevent this problem. Doxorubicin can weaken the heart muscle over time, so doctors must limit the amount of this drug that is used. Mitoxantrone can rarely cause leukemia, so it is no longer being studied for use in early prostate cancer.
The side effects of chemotherapy are usually short-term and go away once treatment is finished. There is help for many of these side effects. For example, drugs can be given to prevent or reduce nausea and vomiting. Other drugs can be given to boost blood cell counts.
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