When your doctor mentions chemotherapy to treat prostate cancer, your first thoughts might jump straight to some side effects usually associated with treatment, like hair loss, feeling weak or extremely exhausted, and more.
But chemotherapy (chemo) has changed a lot over the years and doesn’t affect everyone the same way, so it’s important not to jump too far ahead. Your doctor, nurse, or care team will best be able to prepare you for your exact treatment plan.
Below we’ll provide some basic information to help you understand chemo better and how to manage side effects. This can be a stressful and uncertain time, so it’s important that you get the information you need to make the best decisions for you.
What is chemotherapy and how is it used to treat prostate cancer?
Chemo works by using anti-cancer drugs to kill cancer cells or stop them from growing and dividing. Chemo can slow down the growth of prostate cancer or delay symptoms, but it can’t cure the cancer.
While chemo may be given in different ways for different forms of cancer, in prostate cancer treatment it is given through an intravenous (IV) tube placed into a vein using a needle.
Before deciding to have chemo, carefully consider your options and talk to your doctor, nurse, care team, and your family.
Being a good candidate for chemotherapy to treat prostate cancer
If you have advanced (or metastatic) prostate cancer, you might have chemo as your first phase of treatment.
Chemo can also be given at the same time as hormone therapy or after your hormone therapy stops working (for castration-resistant prostate cancer). The combination of chemotherapy and hormone therapy can help men live longer and delay further pain. And given on its own, after hormone therapy stops working, chemo may help you live longer and delay or manage symptoms.
Speak to your doctor and care team to learn if a chemo treatment plan may be right for you.
How is the chemotherapy given?
If you decide to have chemo, you’ll likely be referred to a medical oncologist (although you may already have one). In some cases, your urologist can also supervise your chemotherapy.
The chemo is given in ‘sessions’ (also called ‘cycles’) that are usually 2-3 weeks or 3-4 weeks long. You’ll receive the treatment on the first day of the cycle and then there will be a rest period to allow your body to recover from the effects of the drug. Each ‘cycle’ includes time for treatment and time for rest. The exact number of cycles you’ll have depends on a few factors, including how well it is working and the side effects.
Your doctor or nurse will discuss your treatment plan with you and explain what to expect in your sessions, including:
The type of chemo you’ll have.
What the treatment will involve.
The usual number of treatment sessions (cycles).
The length of each session (cycle).
Side effects you might experience.
The tests you’ll need before, during, and after treatment.
This is all to make sure you understand your customized plan, what to expect, and how to manage any side effects.
Your doctor will monitor you after each cycle. You’ll be given steroid tablets to take alongside chemotherapy, which can cause additional side effects.
Each chemo infusion usually takes about an hour but the visit to the chemotherapy treatment area will be longer as the nurses will ensure they do a full assessment and make sure that everything is okay before you leave. It does not require an overnight stay. You can probably head straight back home, depending on how your body reacts to treatment and what your care team advises.
What type of chemotherapy is used to treat prostate cancer?
There are different prostate cancer chemotherapy drugs used for treatment.The most common are docetaxel and carbazitaxel. Rarely, a drug called mitozantrone might be used. You can learn more about each of these below.
Docetaxel is commonly used as the first chemotherapy drug for advanced prostate cancer. It may be combined with hormone therapy for men who have just been diagnosed with advanced prostate cancer that is hormone sensitive, and sometimes for locally advanced prostate cancer. It can also be used for men who have cancer that has stopped responding to hormone therapy, also known as castrate-resistant prostate cancer. It is usually given as an injection into your veins every 3 weeks and is typically well-tolerated. Some men see an improvement in symptoms while on treatment. It has also been shown to help some men live longer.
While on docetaxel, it’s important to closely monitor for signs of infection as your white blood cell count may go low. Some men experience a white cell count low enough to need medical attention.
You might be offered cabazitaxel if you have advanced prostate cancer that has stopped responding to hormone therapy and you've already had docetaxel.
Cabazitaxel is typically used as a second defense after docetaxel has been tried but the cancer has continued to progress. As with docetaxel, cabazitaxel cannot cure the prostate cancer, but can help prolong life and reduce symptoms. It’s also usually given as an injection in your veins, every 3 weeks.
Mitoxantrone is used to treat advanced prostate cancer that has stopped responding to hormone therapy. It is rarely used now. However, it may be offered if your doctor thinks you may not tolerate the side effects of docetaxel well. Your doctor will make that judgement based on your level of fitness and any other health issues you may have.
What are some common side effects of chemotherapy for prostate cancer?
Chemotherapy targets cells that grow quickly, like cancer cells, and kills them off. Unfortunately, chemo can’t target cancer cells only, so it may kill healthy cells as well, causing side effects.
Everyone reacts differently to chemo as a prostate cancer treatment. Some people experience more severe side effects, while others find it pretty manageable. Your experience with chemo can be affected by other factors such as your level of fitness and any other health conditions you may have.
Fatigue or extreme tiredness.
Loss of appetite or nausea.
Hair thinning or loss.
Common side effects of chemotherapy include:
More bleeding and bruising than normal (due to low blood counts).
Bowel issues (usually looser bowel movements).
Changes in taste.
Changes in your nails.
Watery eyes or a runny nose.
Numbness or tingling in your hands and feet.
Fluid build-up in your body (fluid retention).
You might also experience:
Note: Most people do not get nausea or vomiting with the chemotherapy used to treat prostate cancer. But if you do, your health care team will provide you with medications to help prevent and control this.
What can help with chemotherapy side effects?
Getting good rest, eating well, and having an exercise program are key. Your health care team may be able to refer you to a cancer support exercise program or an exercise physiologist to create or look over your exercise plan. They can also recommend a dietitian to make sure you’re eating the right foods.
Your doctor can also prescribe medications to help make your side effects more manageable. Be sure to talk to your care team if any of them become a problem for you.
If you're feeling very ill from chemo, call the contact numbers your cancer care team would have given you to reach them during the day or emergency contacts during the evenings. If you cannot reach anyone, call an ambulance or go to the nearest hospital emergency room.
Watch for infections
Going through chemo can mean your body is not able to fight off infections very well. This is because the number of white blood cells that help fight infections will be lowered by the chemo drugs. If the number of white blood cells becomes very low, you could get a serious infection. Signs of infection include a change in temperature, sore throat, chills, sweating or generally feeling unwell.