Chemotherapy uses anti-cancer drugs to kill the prostate cancer cells, wherever they are in the body. Chemotherapy won’t get rid of your prostate cancer, but aims to shrink it and slow down its growth. This helps some men to live longer, and can help to control or delay symptoms such as pain.

You might be offered chemotherapy if:
• your cancer has spread from your prostate to other parts of your body (known as advanced or metastatic prostate cancer), and
• it’s not responding as well as it was to hormone therapy.

Prostate cancer is not usually treated with chemotherapy at an early stage, although some men might be offered it at an earlier stage as part of a clinical trial.

You need to be fairly fit to have chemotherapy because the side effects are sometimes hard to deal with. If your doctor thinks you might benefit from chemotherapy, they will do some tests, such as blood tests, to make sure it’s suitable for you.

There are several chemotherapy drugs that are used to treat prostate cancer, including docetaxel (Taxotere®), cabazitaxel (Jevtana®) and mitoxantrone (Novantrone®). You will also take other medicines with your chemotherapy, such as steroids to help make it more effective and lower the risk of side effects.

If you’re having hormone therapy with LHRH agonists (luteinizing hormone-releasing hormone agonists), you’ll usually keep taking it during chemotherapy, as it might still help to control your cancer. You may also have other treatments to manage any symptoms you may have, such as radiotherapy, bisphosphonates and pain-relieving drugs.

What other treatments are available?

 

 

What are the advantages and disadvantages?

An advantage for one person might not be for someone else. Speak to your doctor or nurse before deciding whether to have chemotherapy – they’ll be able to help you weigh up the pros and cons.

Advantages

  • Chemotherapy might shrink the cancer or slow down its growth. This may help some men live longer.
  • It can help to control or delay symptoms such as pain, which can improve how you feel in your day-to-day life.
  • Most men are able to leave hospital on the day of their treatment – there’s usually no need to stay overnight.
  • You may have more regular check-ups, tests and support from your medical team than usual, which some men find reassuring.

Disadvantages

  • You will have hospital appointments every few weeks. This can go on for a few months.
  • Chemotherapy affects each man differently, and it may not work so well for everyone.
  • It can cause side effects which can be difficult to deal with.
  • You may also get side effects from the steroids you take with the chemotherapy.

What does treatment involve?

Most types of chemotherapy are given as a course of up to 10 sessions (also called cycles) of treatment. There’s usually a break of three weeks between each session.

Before each treatment session begins, your doctor or nurse will check how you’re feeling and how you’re dealing with any side effects. You will also have blood tests to check:

  • that the levels of different blood cells (your blood count) are in the normal range - chemotherapy can lower your blood count which can cause side effects
  • how well your liver and kidneys are working – they are involved in how your body handles chemotherapy drugs.  

At each treatment session, the chemotherapy will be given through a drip (intravenous infusion). This usually involves running the medicine through a thin tube into a vein. Treatment usually takes about one hour and the tube will be removed before you go home.

You will have regular check-ups to check your PSA (prostate specific antigen) level, and discuss any symptoms or side effects you may have. If your PSA level falls or your symptoms improve, for example you have less pain, this usually suggests that the chemotherapy is working.

What are the side effects?

As well as damaging cancer cells, chemotherapy can affect some healthy cells, and this can cause side effects. The side effects will affect each man differently, and you may not get all of them. Most of them are temporary and will gradually go away after you finish treatment.

The most common side effects are listed below. Each type of chemotherapy can cause its own particular side effects – so ask your doctor or nurse about the possible side effects of the type you’re having.

  • A higher risk of infection
  • Feeling breathless, tired or weak
  • Bleeding and bruising more easily
  • Extreme tiredness (fatigue)
  • Feeling and being sick (nausea and vomiting)
  • Loss of appetite
  • Sore mouth
  • Bowel problems, such as loose and watery stools (diarrhoea), or difficulty emptying your bowels (constipation)
  • Hair loss
  • Fluid retention, which can cause your ankles or legs to swell, or make you feel a bit bloated
  • Numbness or tingling in the hands and feet (peripheral neuropathy)
  • Nail changes  – your finger nails and toe nails grow more slowly, or become hard, brittle or flaky
  • Watery eyes
  • Changes to your mood – some people say they feel down at certain times during their chemotherapy

It’s important to tell your doctor or nurse if you get any of these side effects. 

Signs of infection
Contact the hospital immediately if you get any signs of infection. These include a fever (high temperature), sweating, chills and shivering, or a sore throat.

In general it’s safe to be around other people when you’re having chemotherapy, including children and pregnant women. But you should try to avoid crowded places and contact with people who have an infection, to keep the chances of getting an infection down.

Questions to ask your doctor or nurse

  • How can chemotherapy help?
  • Which chemotherapy would be most suitable for me?
  • How long will the treatment last? How many sessions will I need?
  • Are there any activities I should avoid between sessions, such as driving or swimming?
  • What are the possible side effects of chemotherapy, and how long will they last?
  • Can I stop the treatment if I find the side effects difficult to deal with?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Who will I see after my treatment finishes, and how often will I have check-ups?
  • Will having chemotherapy affect my treatment options later on?
  • What happens if chemotherapy doesn’t work? Are there other treatments I can have?
  • Are there any other treatments available to me?
  • Are there any clinical trials I can take part in?

References

  • Full list of references used to produce this page  

    1. Collins R, Trowman R, Norman G, Light K, Birtle A, Fenwick E, et al. A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer. Br J Cancer. 2006 Aug 1;95(4):457–62.

    2. Bahl A, Oudard S, Tombal B, Ozguroglu M, Hansen S, Kocak I, et al. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial. Ann Oncol. 2013 May 30;24(9):2402–8.

    3. Heidenreich A, Aus G, Abbou CC, Bolla M, Joniau S, Matveev V, et al. Guidelines on Prostate Cancer. European Association of Urology. 2013 [cited 2013 Dec 18]; Available from: http://www.infosan.org/pdf/242/eau1633.pdf

    4. Colloca G, Venturino A, Checcaglini F. Patient-reported outcomes after cytotoxic chemotherapy in metastatic castration-resistant prostate cancer: A systematic review. Cancer Treat Rev. 2010 Oct;36(6):501–6.

    5. Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, et al. Abiraterone in Metastatic Prostate Cancer without Previous Chemotherapy. N Engl J Med. 2013 Jan 10;368(2):138–48.

    6. National Cancer Drugs Fund List (Updated 26 June 2013). NHS England [Internet]. 2013. Available from: http://www.england.nhs.uk/wp-content/uploads/2013/06/ncdf-list1.pdf

    7. National Collaborating Centre for Cancer (Great Britain). Prostate cancer: diagnosis and treatment : full guideline, February 2008. Cardiff: National Collaborating Centre for Cancer; 2008.

    8. De Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels J-P, Kocak I, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010 Oct 2;376(9747):1147–54.

    9. Serpa Neto A, Tobias-Machado M, Kaliks R, Wroclawski ML, Pompeo ACL, Del Giglio A. Ten Years of Docetaxel-Based Therapies in Prostate Adenocarcinoma: A Systematic Review and Meta-Analysis of 2244 Patients in 12 Randomized Clinical Trials. Clin Genitourin Cancer. 2011 Dec;9(2):115–23.

    10. Singer EA, Srinivasan R. Intravenous therapies for castration-resistant prostate cancer: Toxicities and adverse events. Urol Oncol Semin Orig Investig. 2012 Jul;30(4):S15–S19.

    11. Tipton JM, McDaniel RW, Barbour L, Johnston MP, Kayne M, LeRoy P, et al. Putting Evidence Into Practice: Evidence-Based Interventions to Prevent, Manage, and Treat Chemotherapy-Induced Nausea and Vomiting. Clin J Oncol Nurs. 2007 Feb 1;11(1):69–78.

    12. Doyle-Lindrud S. Managing Side Effects of the Novel Taxane Cabazitaxel in Castrate-Resistant Prostate Cancer. Clin J Oncol Nurs. 2012 Jun 1;16(3):286–91.

    13. NICE. Abiraterone for castration- resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen TA259. 2012.

    14. Husson O, Mols F, Poll-Franse LV van de. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2010 Sep 24;mdq413.