What is chemotherapy?

Chemotherapy uses anti-cancer drugs to kill prostate cancer cells, wherever they are in the body. It doesn’t get rid of prostate cancer, but it aims to shrink it and slow its growth.

Research shows that the chemotherapy drugs docetaxel and cabazitaxel can help some men to live longer. Chemotherapy can also delay or help to improve any symptoms you have, such as pain.

You will also take other medicines with your chemotherapy, such as steroids. These help make chemotherapy more effective and lower the risk of side effects.


Who can have chemotherapy?

Chemotherapy is usually only an option if you've been diagnosed with prostate cancer that has spread from your prostate to other parts of your body (advanced prostate cancer).

  • You might be offered chemotherapy alongside hormone therapy if you've just been diagnosed with advanced prostate cancer. This helps many men to live longer, and can help to improve or delay symptoms such as pain.
  • You might be offered chemotherapy if you've already had hormone therapy to treat advanced prostate cancer, and your cancer is no longer responding to the hormone therapy. This may help some men to live longer, and can help to improve symptoms.

Unlike other kinds of cancer, 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 to make sure it’s suitable for you. For example, they will do some blood tests to check how well your liver and kidneys are working. This is because the liver and kidneys are involved in how your body handles chemotherapy drugs.

Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Chemotherapy can also be used to treat rare types of prostate cancer, such as small cell prostate cancers. If you have been diagnosed with a rare type of prostate cancer, you may have a different type of chemotherapy to those discussed on this page.

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.


  • 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.


  • 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

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’ll have a blood test to check that the levels of different blood cells (your blood count) are in the normal range. This is important because chemotherapy can cause the level of blood cells to drop.

If your blood count isn’t high enough to cope with a session of treatment, your doctor may decide to reduce the amount of chemotherapy they give you (reduce the dose). They might also decide to delay the session and continue with treatment once your blood count returns to normal. Or you may be given a drug to help your body produce more blood cells.

You will also have blood tests to check how well your liver and kidneys are working. This is because the liver and kidneys are involved in how your body handles chemotherapy drugs.

Your doctor might decide to stop your treatment if you have severe side effects or your cancer continues to grow during treatment. Every man responds differently to chemotherapy. Some men find the side effects difficult to deal with and decide to stop treatment. If you’re thinking about stopping treatment, speak to your doctor or nurse.


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’ll be given steroid tablets, such as prednisolone or dexamethasone, to take alongside chemotherapy. You might need to start these before your first treatment session and keep taking them throughout treatment. Or you might just take them for a few days around the time of each treatment session. Your doctor will give you more information about this.

The steroids help make chemotherapy more effective, and lower the risk of side effects. They may also help improve your appetite and energy levels, and can treat pain.

You should be given a steroid treatment card, which explains that you’re taking steroids. You should carry this with you at all times and show it to anyone treating you (such as a doctor, nurse or dentist) – it’s important they know you’re taking steroids.

After each treatment session

Your doctor or nurse will explain what to look out for after treatment, such as signs of infection, bleeding or feeling very tired or breathless (see below), and what to do if you notice any of these things.

What chemotherapy drugs are used?

There are several chemotherapy drugs that are used to treat prostate cancer, including docetaxel (Taxotere®), cabazitaxel (Jevtana®) and mitoxantrone (Novantrone®).

Docetaxel (Taxotere®)

In the UK, docetaxel is the standard chemotherapy for men with advanced prostate cancer.

Cabazitaxel (Jevtana®)

You might be offered cabazitaxel if you’ve already had treatment with docetaxel. You may hear cabazitaxel called second-line chemotherapy because it’s used after you’ve already had one course of chemotherapy.

Cabazitaxel is licensed in the UK but it’s not available everywhere on the NHS. If your doctor thinks it’s suitable for you, they might be able to apply to get it for you. Speak to your doctor or nurse for more information.

Mitoxantrone (Novantrone)®

Mitoxantrone isn’t often used to treat prostate cancer. But it might be offered if your doctor thinks you may not be able to deal with the side effects of docetaxel. This will depend on how fit and well you are, and if you have any other health conditions.

What are the side effects?

Like all treatments, chemotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Before you start treatment, talk to your doctor or nurse about the side effects. Knowing what to expect can help you deal with them.

Most of the side effects are temporary and will gradually go away after you finish treatment.

As well as damaging cancer cells, chemotherapy can also affect some healthy cells, and this can cause side effects. These include the cells in:

  • hair follicles – which are responsible for hair growth
  • finger and toe nails  
  • bone marrow
  • the lining of the mouth
  • parts of the gut, such as the bowel.

Tell your doctor or nurse about any side effects you have as soon as you get them. There are treatments available to help improve them, and things you can do for yourself to help manage them.

Side effects can happen with all types of chemotherapy. The most common ones are described here. But there are others which are less common, and each type of chemotherapy can also cause its own particular side effects. Ask your doctor or nurse about the possible side effects of the chemotherapy you’re having.

Temporary bone marrow problems

Chemotherapy affects how well your bone marrow works. Bone marrow is the spongy material that fills some of our bones. It makes red and white blood cells and other cells called platelets. There may be a drop in the levels of any of these cells during chemotherapy, and this can cause side effects. This usually happens about 7-10 days after each treatment session.

  • You may be more at risk of getting an infection. This is caused by a drop in the number of white blood cells, which help fight infection. You might hear this called neutropenia. If you get an infection while you’re on chemotherapy, you could become very unwell. See below for more about infections and when to contact your doctor or nurse if you think you might have one.
  • You may feel breathless, tired or weak. This can be caused by a drop in the number of red blood cells, which means not enough oxygen is carried around the body. This is known as anaemia. If this happens, your doctor may delay your next treatment session to give your red blood cells time to recover. If your level of red blood cells falls very low, you may need to have a blood transfusion.
  • You may bleed and bruise more easily. This can be caused by a drop in the number of platelets – which help your blood to clot. You may notice you have nose bleeds or bleeding gums. There are things you can do to lower the risk of bleeding, for example, using a softer toothbrush and an electric shaver, rather than a razor. Some men with advanced prostate cancer notice some blood in their urine, and cabazitaxel can make this worse.

Your doctor or nurse will be able to suggest ways to help prevent some of the problems caused by a low blood count.


During chemotherapy your body might be less able to fight off infections. It’s important to contact the hospital immediately if you think you might have an infection because it could make you very unwell.

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. Speak to your doctor about whether using swimming pools will be safe for you.


Speak to your doctor about any vaccinations you’re planning to have.

You should avoid having a type of vaccination called a live vaccine during your treatment and for at least six months afterwards. Shingles and yellow fever are both live vaccines, for example. It is safe to be around others who have had these types of vaccines.

Other vaccinations such as the flu jab or the pneumonia jab are safe, but may not give you as much protection as usual because your immune system may be weaker. It’s always best to check with your doctor or nurse before having a vaccination.

Extreme tiredness (fatigue)

Many people say that fatigue is the most difficult side effect to cope with. Fatigue is extreme tiredness or exhaustion, which makes it hard to carry out your daily activities. Some men describe feeling weak, lethargic, knackered or drained.

Fatigue is usually worse towards the end of your treatment. Most people find their energy levels improve after finishing treatment, but for some, fatigue can be long-lasting.

Sometimes there is a specific cause for your tiredness, like low levels of red blood cells (see above). And tiredness can be caused by things other than your treatment. For example, the cancer itself can make you feel tired, and so can feeling anxious or depressed.

Get help with fatigue.

Feeling and being sick (nausea and vomiting)

Chemotherapy for prostate cancer is not as likely to make you feel sick as some other types of chemotherapy. And there are a number of anti-sickness medicines (anti-emetics) that can help to control this side effect. If you do feel sick, your doctor or nurse can also talk you through other things you can try, for example foods to eat or avoid, and relaxation techniques .

If the smell of food is putting you off eating, try to avoid strong-smelling foods and go for cold foods more often as they don’t usually smell as much. If possible, ask someone to make your meals for you. You may also find it helps to avoid fried, greasy or very sweet foods. Some people find things flavoured with peppermint or ginger can help, such as flavoured teas or sweets.

Let your GP or doctor or nurse at the hospital know if you continue to feel or be sick.

Loss of appetite

You might lose your appetite during chemotherapy. This can happen because of some of the side effects of treatment such as feeling sick or having a sore mouth (see below). Chemotherapy can also make food taste different – it might taste more salty, bitter or metallic, or it might lose its taste.

Some people find sucking on boiled sweets can leave a pleasant taste in their mouth. And if you don’t feel like eating much, it’s important to drink plenty of fluids and to find foods that are more appealing to you. Eating small meals and having regular snacks that are high in calories and protein might also help you to get the energy and nutrients you need, and help to reduce weight loss.

The steroids you take with your chemotherapy should help improve your appetite. But if you’re having problems eating a balanced diet or if you’re losing weight, talk to your doctor or nurse. You might be referred to a dietitian who specialises in helping people with cancer. 

Sore mouth

Some chemotherapy drugs can make your mouth sore, but this is uncommon. You may develop ulcers or inflamed gums , which can be painful. This is because you’re less able to fight infection than normal. There are things that might help to prevent and relieve a sore mouth.

  • Brush your teeth gently twice a day with a soft toothbrush, and use mouth washes regularly.
  • Be very careful when flossing, and avoid using tooth picks. You can ask your doctor or dentist about whether it’s safe to floss and what to use.
  • Try making small changes to your diet such as choosing soft, moist foods and avoiding foods that are acidic, spicy, very hot or very cold.
  • Try drinking through a straw.

Your nurse can give you more information about taking care of your mouth. If it gets very sore, your doctor might prescribe pain-relieving drugs to help.

Bowel problems

Some types of chemotherapy may make your stools loose and watery (diarrhoea). This usually happens in the first few days after treatment. Other chemotherapy drugs and some anti-sickness medicines can make it difficult to empty your bowels (constipation). Bowel problems can usually be controlled with medicines or changes to what you eat, so let your doctor or nurse know about any problems you’re having.

Make sure you’re drinking enough water – about eight glasses (two litres) a day. This will help to replace the water that’s lost with diarrhoea, and will also help to prevent constipation. It might also be a good idea to avoid fatty, fried, and spicy foods, as some men find they can make diarrhoea worse.

Hair loss

Hair loss is a temporary side effect of some chemotherapy drugs. It happens gradually and tends to start two or three weeks after treatment starts. Your hair will usually begin to grow back after you’ve finished treatment. Some men choose to wear a hat or wig until their hair has grown back.

To help reduce hair loss, scalp cooling may be suitable for some people. Scalp cooling involves wearing a special cap during each treatment session. The cap is filled with a chilled gel or connected to a small refrigerated cooling system. It doesn’t work for everyone and may not be available in every hospital. If you’re interested in scalp cooling, speak to your doctor or nurse.

Fluid retention

This can cause your ankles or legs to swell or you might feel a bit bloated . This can also be a side effect of steroids. If it does happen, it should improve after you finish treatment.

Numbness or tingling in the hands and feet

Chemotherapy can affect your nerves. This can cause numbness or tingling in your hands and feet (peripheral neuropathy). This usually improves slowly a few months after treatment finishes.

It’s important to tell your doctor or nurse if you get this. If it’s severe, your doctor might decide to reduce the amount of chemotherapy you have at each treatment session (reduce the dose). Or they might offer a different treatment.

Numbness and tingling can have other causes, including the cancer itself. You may need to have some tests to check what’s causing it.

Nail changes

You may find that your finger nails and toe nails grow more slowly, or become hard, brittle or flaky. The shape or colour of your nails might also change. These changes are temporary and should improve after treatment, though it can take a few months.

There are ways to protect your nails during chemotherapy. For example, you can keep your nails trimmed short and wear protective gloves while doing jobs around the house.

Watery eyes

Your eyes might produce more tears than normal. This isn’t common and won’t last long. If your eyes feel sore, inflamed or watery, let your doctor know – they can prescribe eye drops if necessary.

Changes to your mood

Some people say they feel down at certain times during their chemotherapy. This is natural and should usually only last a short time, but some men find they still feel low after their treatment finishes. If you’re feeling really low and finding it hard to deal with things, do speak to your doctor or nurse – there are things that can help and there is support available.

Side effects of steroids

You may get side effects from the steroids you take with your chemotherapy. Possible side effects include indigestion and irritation of the stomach lining, feeling irritable or restless, and fluid retention which can cause swollen hands and feet. Other less common side effects will be listed in the leaflet that comes with your medicine.

Speak to your doctor or nurse about the side effects of steroids.

What happens afterwards?

After you finish your course of chemotherapy, you will have regular check-ups to monitor how well your treatment is working and any side effects. Your doctor or nurse will let you know how often your appointments will be and what they will involve.

You will have regular PSA test to measure the level of a protein called PSA (prostate specific antigen) in your blood to check how well your treatment is working. Your doctor will also ask you about any side effects from your treatment and any symptoms you might have. If your PSA level falls or your symptoms improve, for example you have less pain, this usually suggests that chemotherapy is working.

Sometimes PSA levels can rise after starting chemotherapy, then come back down again. So a rise in PSA doesn’t necessarily mean that your chemotherapy isn’t working.

Are there other treatments available after chemotherapy?

If your cancer starts to grow again after you finish treatment, you may be able to have further treatment. Which treatments you are offered will depend on how well you are, any symptoms you have, which treatments you’ve had before, and any other health conditions you have. Your doctor should discuss your options with you to help you decide what’s best for you.

More chemotherapy

If you’ve already had docetaxel, you might be offered cabazitaxel. This is sometimes called second-line chemotherapy.

Abiraterone (Zytiga®)

This is a new type of hormone therapy. It’s available on the NHS for men who’ve had docetaxel chemotherapy.

Enzalutamide (Xtandi®)

Enzalutamide is a new type of hormone therapy for men whose prostate cancer has stopped responding to other types of hormone therapy and chemotherapy.

It isn’t widely available on the NHS at the moment. If your doctor thinks it’s suitable for you, they may be able to apply for you to get it.

For more information on abiraterone or enzalutamide, speak to your doctor or nurse, or call our Specialist Nurses.

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?


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