Chemotherapy for Prostate Cancer

Chemotherapy (chemo) uses anti-cancer drugs, given into a vein or taken by mouth, to reach cancer cells throughout most of the body.

When is chemotherapy used for prostate cancer?

Chemo isn’t part of the treatment for most men with prostate cancer, but it can be used to treat advanced prostate cancer, especially if there is a lot of cancer outside the prostate gland.

Doctors use chemo in 2 main situations:

• For initial treatment with hormone therapy: Some men have a lot of cancer that has spread but still responds to hormone therapy. Doctors call this high-volume metastatic castration-sensitive prostate cancer. For these men, adding the chemo drug docetaxel to hormone therapy from the start can help them live longer than hormone therapy alone. Some men also get a third drug, a newer anti-androgen, added to the hormone therapy and docetaxel.
• After hormone therapy stops working: Sometimes prostate cancer keeps growing despite hormone therapy. Doctors call this androgen pathway modulation-resistant prostate cancer, also called castration-resistant prostate cancer. Chemo can treat it, either alone or alongside continued hormone therapy.

Chemo is not a standard treatment for early prostate cancer.

Chemo drugs used to treat prostate cancer

Doctors typically give one chemo drug at a time for prostate cancer. Drugs used include:

• Docetaxel
• Cabazitaxel
• Mitoxantrone
• Estramustine (doctors use this drug less often today because of its side effects, including a higher risk of blood clots)
• Carboplatin

Docetaxel is usually the first chemo drug given, typically combined with a steroid such as prednisone or dexamethasone. If docetaxel stops working, doctors often try cabazitaxel next, combined with a steroid, though other options may be available too.

Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may shrink the cancer or slow its growth, and they may also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.

Other chemo drugs are being studied for use in prostate cancer treatment as well.

How is chemotherapy given?

Chemo drugs for prostate cancer are typically given into a vein (using an IV or central line) as an infusion over a certain period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the side effects. Cycles are most often about 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

How long you’ll get chemo depends on how well it’s working and what side effects you have.

Possible side effects of chemotherapy

Chemo drugs attack 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 (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Higher risk of infection (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts)

These side effects usually go away once treatment is finished. There are often ways to lessen these side effects. For example, drugs can help prevent or reduce nausea and vomiting.

Some side effects show up more often with certain drugs:

• Docetaxel and cabazitaxel sometimes cause severe allergic reactions. Medicines are given before each treatment to help prevent this. These drugs can also damage nerves (known as peripheral neuropathy), which can cause numbness, tingling, or burning sensations in the hands or feet.
• Mitoxantrone can, very rarely, cause leukemia several years later.
• Estramustine carries an increased risk of blood clots.

If you notice any side effects while getting chemo, tell your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced, or treatment may need to be delayed or stopped to prevent the effects from getting worse.