This page has information on chemotherapy, which can be used to treat advanced prostate cancer – cancer that has spread from the prostate to other parts of the body.
Here we describe how chemotherapy can be used to treat prostate cancer, as well as the possible side effects.
Chemotherapy is usually only used to treat advanced prostate cancer. If you've been diagnosed with localised prostate cancer that hasn't spread outside the prostate, read our information on treatments for localised prostate cancer instead.
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We have information on having chemotherapy during the coronavirus outbreak.
What is chemotherapy?
Chemotherapy uses anti-cancer (cytotoxic) drugs to kill cancer cells, wherever they are in the body. It won’t get rid of your prostate cancer, but it aims to shrink it and slow down its growth.
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).
- Chemotherapy as a first treatment for advanced prostate cancer. If you’ve just been diagnosed with advanced prostate cancer, you might be offered chemotherapy at the same time as, or soon after, you start another treatment called hormone therapy. This helps many men to live longer, and may help to delay symptoms such as pain.
- Chemotherapy as a further treatment for advanced prostate cancer. You might be offered chemotherapy later on if your cancer is no longer responding to hormone therapy. This may help some men to live longer, and can help to improve and delay symptoms.
You need to be quite fit to have chemotherapy because the side effects can be harder to deal with if you have other health problems. If your doctor thinks you might benefit from chemotherapy, they will do some tests to make sure it is suitable for you.
Chemotherapy for locally advanced prostate cancer
Chemotherapy to treat rare prostate cancers
Although prostate cancer is a common cancer in men, there are different types of prostate cancer, and some of these are rare. Chemotherapy can 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 that isn’t discussed on this page. Read more about rare prostate cancers.
If your cancer hasn’t spread outside your prostate (localised prostate cancer), you won’t normally have chemotherapy because other treatments work better. This is different to some other types of cancer, which are often treated with chemotherapy first.
What are the advantages and disadvantages of chemotherapy?
Your doctor or nurse can help you think about the advantages and disadvantages of chemotherapy. What may be important for one person might be less important for someone else. Give yourself time to think about whether chemotherapy is right for you.
Advantages of chemotherapy
- Chemotherapy might shrink the cancer or slow down its growth. This can help men to live longer.
- It can help to improve or delay symptoms such as pain, which can improve how you feel in your day-to-day life.
- Most men can leave hospital on the day of their treatment – there’s usually no need to stay overnight.
- You may have more regular check-ups and tests, which some people find reassuring.
Disadvantages of chemotherapy
- You will need to have hospital appointments every few weeks.
- 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. But there are usually ways to manage them.
- Some side effects, such as hair loss, can be hard to hide – this can be a problem if you haven’t told people about your diagnosis.
- Some side effects, like infections, can be fatal if they’re not treated. But this is very rare. If you’re worried, talk to your doctor or nurse.
- You may be given steroid tablets to take alongside chemotherapy. These can cause side effects too.
Making a decision about having chemotherapy
If you’re offered chemotherapy, speak to your doctor or nurse about the advantages and disadvantages before deciding whether to have it. We’ve included a list of possible questions to ask below. You could also talk through your options with your partner, family or friends, or speak to our Specialist Nurses.
Are there other treatment options for advanced prostate cancer?
Some men with advanced prostate cancer have hormone therapy on its own. When this stops working so well, there are other treatments available such as newer types of hormone therapy. Ask your doctor or nurse about other possible treatments, including any clinical trials, before you decide.
Will chemotherapy affect other treatments I’m having?
If you’re having hormone therapy injections, you’ll usually keep having them alongside chemotherapy. This is because the hormone therapy might still help to control your cancer.
Let your doctor know if you’re taking other medicines – including supplements (such as vitamins and minerals) or herbal remedies. You may need to stop taking them while you’re having chemotherapy, as they could interfere with your treatment.
What does treatment involve?
If you decide to have chemotherapy, you will be referred to an oncologist (a doctor who specialises in cancer treatments), and a chemotherapy nurse.
Your doctor or nurse will discuss your treatment plan with you. They’ll explain which medicines you’ll have, what the treatment will involve and what the possible side effects may be. They’ll also tell you about any tests you’ll need before, during and after your treatment.
If you start chemotherapy soon after you’ve been diagnosed, alongside hormone therapy, you will have up to six sessions (also called cycles) of treatment. There is no set time when you should start chemotherapy and it is different for every man. It’s usually fine to start chemotherapy any time up to three months after starting hormone therapy.
If you’ve already had hormone therapy, chemotherapy is usually given as a course of up to 10 sessions. But this might not be the same for everyone.
You’ll usually have treatment every three weeks. To begin with, your doctor will monitor you after each session to check that your treatment is working and you don’t have too many side effects.
Before each treatment session
A few days before each session you’ll have a blood test to check that the levels of different blood cells (your blood count) are in a normal range to have treatment. This is important because chemotherapy can cause the level of white blood cells, red blood cells and platelets to drop.
If your white blood cell count is low, you might not be able to have your treatment as planned. White blood cells fight infection. If your white blood cell count is too low, you are at risk of getting infections which can make you very unwell. Your doctor may decide to reduce the amount (dose) of chemotherapy they give you. Or they might delay the session until your white blood cell count returns to normal. You may also be given a drug called GCSF (granulocyte colony stimulating factor) to help your body produce more white blood cells. Read about the side effects of GCSF.
If your red blood cell count is low, your blood may not be able to carry enough oxygen around your body. This can make you feel tired, weak and breathless. Your doctor may offer you a blood transfusion to boost your number of red blood cells. This will be given through a drip (intravenous infusion) into a vein in your arm.
You will also have blood tests to check how well your liver and kidneys are working. This is because the liver and kidneys break down the chemotherapy drugs and get rid of them from the body. If they’re not working properly, the drugs will stay in your body for longer and you could have a higher risk of side effects.
Before each treatment session begins, your doctor or nurse will check how you’re feeling and how you’re dealing with any side effects.
Your doctor might decide to stop your treatment if you have severe side effects or your cancer continues to grow. Every man responds differently to chemotherapy. Some men find the side effects difficult to deal with and decide to stop treatment. If you want to stop treatment, speak to your doctor or nurse.
During your treatment
The chemotherapy will usually be given through a drip (intravenous infusion) into a vein in your arm. Treatment normally takes about one hour and the tube (cannula) will be removed from your arm before you go home.
Some types of chemotherapy can be given as tablets or capsules (oral chemotherapy). But this isn’t common, as oral chemotherapy drugs don’t work well for men with prostate cancer.
What chemotherapy drugs are used?
There are two main chemotherapy drugs that are used to treat prostate cancer – docetaxel (Taxotere®) and cabazitaxel (Jevtana®).
In the UK, docetaxel is the most commonly used chemotherapy for men with advanced prostate cancer. It can be used alongside hormone therapy for men who have just been diagnosed with advanced prostate cancer, and sometimes for men with locally advanced prostate cancer. It can also be used if hormone therapy has stopped working so well.
You might be offered cabazitaxel if you have advanced prostate cancer that has stopped responding to hormone therapy and you have already had docetaxel. You may hear cabazitaxel called second-line chemotherapy because it’s used if you’ve already had chemotherapy before.
Treatments to help manage side effects
As well as the chemotherapy drug itself, you might need to take steroids, anti-sickness drugs (anti-emetics), antibiotics and a drug called GCSF. These can help to manage some of the side effects of chemotherapy.
If you’re having docetaxel, you may also be given steroid tablets, such as prednisolone and dexamethasone. 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.
It’s important to take steroids correctly. And don’t suddenly stop taking them, especially if you’ve been taking them for several months, as this could make you ill. Your doctor will give you more information about this.
Steroids can 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. But steroids can cause their own side effects too – read more about the possible side effects of steroids.
Anti-sickness medicines (anti-emetics)
You may be given anti-sickness medicines through a needle into a vein in your arm, before having your chemotherapy. You will also be offered anti-sickness tablets to take for a few days after each chemotherapy session to help stop you feeling sick (nausea) and being sick (vomiting).
You might be given a course of antibiotics to help lower your risk of getting an infection while you’re having chemotherapy. If you do have antibiotics, it’s important to follow the instructions from your doctor and take all the tablets at the right times.
GCSF (granulocyte colony stimulating factor)
If your white blood cell count is too low, you may be given an injection of a drug called GCSF to help your body produce more white blood cells. Read about side effects of GCSF.
After each treatment session
In general most men continue with life as normal while having chemotherapy. It’s safe to be around other people when you’re having chemotherapy, including children and pregnant women.
If you go to the dentist or have any treatment for other health problems, let the dentist or doctor know that you’re having chemotherapy as it can affect other treatments.
If you have any concerns between your appointments, or get any new side effects or symptoms, contact your doctor or nurse. They can often help you find ways to manage them.
When you start your treatment, your chemotherapy nurse should give you details of who to contact at the hospital, including during the night and at weekends. Use this contact number, rather than calling your GP. Remember to call if you have any concerns, even if you think they’re not very important.
If you have a special occasion coming up, such as a wedding or holiday, let your doctor or nurse know in plenty of time. It’s usually fine to delay a chemotherapy session or start the treatment slightly later.
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. Most of them are temporary and will gradually go away after you finish treatment. Before you start treatment, talk to your doctor or nurse about the side effects. Knowing what to expect can help you deal with them.
Chemotherapy targets and kills cells that grow too quickly, such as cancer cells. But it can also affect some healthy cells that also grow quickly, and this can cause side effects. These include the cells in:
- the bone marrow
- the lining of the mouth
- parts of the gut, such as the bowel
- hair follicles – which are responsible for hair growth
- finger and toe nails.
Chemotherapy affects how well your bone marrow works. Bone marrow is the spongy material that fills some of your 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 to 10 days after each treatment session.
Side effects can happen with all types of chemotherapy. The most common side effects are described here. But there are others that are less common, and each type of chemotherapy can also cause its own particular side effects. Tell your doctor or nurse about any side effects as soon as you get them. There are treatments available and things you can do yourself to help manage them.
During chemotherapy your body might be less able to fight off infections. This is caused by a drop in the number of white blood cells in your body. You might hear this called neutropenia. White blood cells are part of your immune system and help fight infection. It’s important to contact the hospital immediately if you think you might have an infection because it could make you very unwell or be fatal if it’s not treated.
It’s important to lower your chances of catching infections from other people. Try to avoid close contact with people who are ill or have an infection and make sure you wash your hands regularly. But you can still spend time with people who are well and it’s fine to have normal contact with your family and friends. It’s important to carry on doing things you enjoy with people you are close to. Ask your doctor for more advice on avoiding infections.
I had a firm telling-off for delaying calling my doctor when I had signs of an infection. I learnt that I must call, even if I think it’s something trivial.
What to do if you think you have an 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.
It’s important to keep a thermometer at home so you can check your temperature if you feel unwell. A fever is a temperature higher than 37.5°C or 99.5°F. If you’re taking steroids, your temperature may not be raised by an infection, so you should contact the hospital straight away if you feel unwell, even without a temperature.
If you can’t get in touch with your medical team, go to your nearest accident and emergency (A&E) department or call 999 and tell them you’re having chemotherapy. Don’t wait to see if your symptoms get better, go in straight away.
You should avoid having a type of vaccine called a live vaccine during your treatment, and for at least six months afterwards. This is because your immune system might not be strong enough to cope. Vaccines against shingles and yellow fever are both examples of live vaccines, so these should be avoided. But it is safe to be around others who have had these vaccines.
Other vaccines 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 vaccine and remind them that you’re having chemotherapy.
Feeling 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.
Bleeding and bruising more easily than normal
This can be caused by a drop in the number of platelets in your blood. Platelets help your blood to clot. A low level of platelets is called thrombocytopenia. You may get nose bleeds or bleeding gums. There are things you can do to lower the risk of bleeding, such as using a softer toothbrush, and an electric shaver rather than a razor. Some men with advanced prostate cancer pass some blood in their urine, and chemotherapy can make this worse.
Extreme tiredness (fatigue)
Many men say that fatigue is one of the hardest side effects to cope with. Fatigue is extreme tiredness or exhaustion, which makes it hard to carry out your daily activities.
During a course of chemotherapy, your energy levels may go up and down. Fatigue is usually worse during the week after each treatment session but then gradually improves. Fatigue usually gets worse as you have more sessions of chemotherapy.
After finishing a course of chemotherapy, most men find their energy levels improve. But for some, fatigue can be long-lasting.
Sometimes there is a specific cause for your tiredness, like low levels of red blood cells. But tiredness can also 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. Visit our interactive online guide for ways to deal 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. If you do feel sick, your doctor can prescribe anti-sickness medicines (anti-emetics). Your doctor or nurse can also talk you through other things that might help, such as 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 choose cold foods 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 herbal teas or sweets.
Loss of appetite
You might lose your appetite during chemotherapy. This can happen because of some side effects, such as feeling sick. 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, fresh or tinned pineapple or taking sips of ginger beer can leave a pleasant taste in their mouth.
If you don’t feel like eating much, it’s important to drink plenty of fluids and to find foods that you enjoy. Eating small meals and having regular snacks that are high in calories can also help you get the energy and nutrients you need.
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. They may be able to refer you to a dietitian who specialises in helping people with cancer.
During chemotherapy, I found that most foods tasted a bit funny. Save your favourite meals for after your treatment has finished.
Some chemotherapy drugs can make your mouth sore, but this isn’t common. You may get ulcers or inflamed gums, which can be painful. There are things that might help.
- 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.
- Choose soft, moist foods and avoid 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.
Some types of chemotherapy may make your bowel movements 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 water that’s lost with diarrhoea, and will also help 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.
Sometimes diarrhoea can be caused by an infection. If you have diarrhoea and you feel unwell or have a temperature, contact your medical team straight away.
Hair loss is a temporary side effect of some chemotherapy drugs. It affects people differently. Some men lose all their hair but many just notice some thinning or have no hair loss at all. Hair loss happens gradually and tends to start two or three weeks after treatment starts. You can lose hair anywhere on your body. 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. This involves wearing a special cap during each treatment session. The cap is filled with a cold gel or connected to a small cooling system. But 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.
You may notice some redness or irritation to your skin if you’re having chemotherapy. Your skin might also be more sensitive to the sun and could burn easily. So even on a cold day, if the sun is shining wear a hat or use sun block. It’s important to protect the skin on your head from the sun, especially if you have hair loss.
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 (peripheral neuropathy). This can cause numbness or tingling in your hands and feet. 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 (dose) of chemotherapy you have at each treatment session. Or they might suggest a different treatment.
Numbness and tingling can have other causes, including the cancer itself. You may need some tests to check what’s causing it.
Changes to your nails
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.
Keeping your nails trimmed short and wearing gloves while doing jobs around the house can help protect your nails. Some research suggests that rubbing natural oils into your nails each day could help to protect them.
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 may prescribe eye drops.
Changes to your mood
Some people say they feel down at certain times during their chemotherapy. This is natural and usually only lasts 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, speak to your doctor or nurse. There are things that can help and there is support available.
My husband kept a daily diary. It was useful to look back after each treatment and say, 'Oh, I’d forgotten how I felt two days after the infusion – it was just the same this time'.
You may also 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 swollen hands and feet. Read more about the possible side effects of steroids.
If you do get side effects, your doctor or nurse may suggest reducing the dose. But don’t do this without speaking to them first.
You might get side effects from GCSF (granulocyte colony stimulating factor) injections, if you are having them. GCSF can cause a skin rash around the injection site, and bone pain in the arms, legs, back and hips. It can also cause a high temperature.
Speak to your doctor or nurse if you are concerned about any of these side effects.
What happens afterwards?
After you finish your chemotherapy, you will have regular follow-up appointments to check how well your treatment is working and monitor any side effects. Your doctor or nurse will let you know how often you’ll have appointments.
You will have regular blood tests to measure your level of PSA (prostate specific antigen). Your doctor will also ask you about any side effects from your treatment and any symptoms you might have. If your PSA level falls, you may find that your symptoms start to get better.
Sometimes PSA levels can rise after having chemotherapy, then come back down again. So a rise in PSA doesn’t necessarily mean that your chemotherapy isn’t working.
Are there further treatments available after chemotherapy?
If your cancer starts to grow again after you finish chemotherapy, you may be able to have other treatments. The aim of further treatment is to control your cancer and delay or manage any symptoms you might have, such as pain.
You might have more than one of the treatments we describe here. Which treatments you are offered will depend on how well you are, any symptoms you have, which treatments you’ve already had, and any other health problems you have. Talk to your doctor or nurse about which treatments are available to you.
- More chemotherapy. If you’ve already had docetaxel and not had any serious problems with it, you might be offered more docetaxel or cabazitaxel.
- Anti-androgens are a type of hormone therapy that stops the hormone testosterone from reaching the prostate cancer cells. You may start taking an anti-androgen, such as bicalutamide (Casodex®), alongside your usual hormone therapy injections. Some doctors call this combined androgen blockade or dual androgen blockade.
- Steroids can stop the adrenal glands producing as much testosterone. They may also improve your appetite and energy levels, and help treat pain. You may have steroids at the same time as other treatments, such as more chemotherapy or a drug called abiraterone.
- Abiraterone (Zytiga®) is a type of hormone therapy for men with advanced prostate cancer that has stopped responding to other hormone therapy treatments. It works by stopping the production of testosterone. It may help some men to live longer and can help to treat or delay symptoms.
- Enzalutamide (Xtandi®) is another type of hormone therapy for men with advanced prostate cancer that has stopped responding to other hormone therapy treatments. It works by blocking the effect of the hormone testosterone on prostate cancer cells. Enzalutamide may help some men to live longer and can help to control symptoms.
- Oestrogens are a type of hormone therapy that can be used to treat prostate cancer that is no longer responding to other types of hormone therapy. Oestrogens aren’t used very often.
- Radium-223 (Xofigo®) is a treatment for men with prostate cancer that has spread to the bones and has stopped responding to hormone therapy. It is a type of internal radiotherapy called a radioisotope. Radium-223 helps some men to live longer and can delay bone problems.
- New treatments and clinical trials. A clinical trial is a type of medical research that aims to find new and improved ways of preventing, diagnosing, treating or managing illnesses. If you decide to take part in a clinical trial, you may be able to have a newer treatment that isn’t yet widely available. To find out about taking part in a clinical trial, ask your doctor or nurse, or speak to our Specialist Nurses.
There are also treatments you can have to help with symptoms of advanced prostate cancer. These treatments treat the symptoms but not the cancer itself. Read more about the symptoms of advanced prostate cancer and how to manage them.
Dealing with prostate cancer
Some men say being diagnosed with prostate cancer changes the way they think and feel about life. If you are dealing with prostate cancer you might feel scared, worried, stressed, helpless or even angry.
At times, lots of men with prostate cancer get these kinds of thoughts and feelings. But there’s no ‘right’ way that you’re supposed to feel and everyone reacts in their own way.
There are things you can do to help yourself and people who can help. Families can also find this a difficult time and they may need support too. Find out more.
Questions to ask your doctor or nurse
- How can chemotherapy help?
- How long will the treatment last, and how many sessions will I need?
- 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?
- Are there any other treatments available to me?
- Who should I contact if I have any questions during my treatment and how do I contact them?
- What happens if chemotherapy doesn’t work? Are there other treatments I can have later on?
- Are there any clinical trials I can take part in?
Updated: August 2018 | Due for Review: September 2020
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