Chemotherapy for Prostate Cancer

Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or given by mouth. These drugs travel through the bloodstream to reach cancer cells in most parts of the body.

When is chemotherapy used?

Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working. Recent research has also shown that chemo might be helpful if given along with hormone therapy. Chemo is not, however, a standard treatment for early prostate cancer.

Chemo drugs used to treat prostate cancer

For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:

• Docetaxel (Taxotere)
• Cabazitaxel (Jevtana)
• Mitoxantrone (Novantrone)
• Estramustine (Emcyt)

In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work (or stops working), cabazitaxel is often the next chemo drug tried (although there may be other treatment options as well).

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

Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.

How is chemotherapy given?

Chemo drugs for prostate cancer are typically given into a vein (IV), either 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.

Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.

Many different kinds of CVCs are available. The most common types are the port and the PICC line.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 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.

The length of treatment for advanced prostate cancer is based on how well it is 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. Some common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

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

Along with the risks above, some side effects are seen more often with certain chemo drugs. For example:

• 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 report them to 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.