Chemotherapy for prostate cancer is the use of anticancer drugs given either orally and through the intravenous route. These drugs reach the cancer cells in the body through the blood.

Chemo, as it is also referred to in short, is used mainly in the treatment of advanced cancer of the prostate.

When prostate cancer spreads beyond the prostate or recurs after treatment, it is often called advanced prostate cancer.

Stage III cancer is cancer that has spread outside the prostate, but only to the neighboring tissues. This is often called “locally advanced prostate cancer.”

Stage IV cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver, or lungs. This stage is often called “advanced prostate cancer.”

When is chemotherapy started for prostate cancer?

Chemotherapy is rarely used in early localized prostate cancer. It is used more in cancer that has recurred. It is also indicated in cancer that has spread outside the prostate gland and especially when hormone therapy has not yielded good results.

Oncologists sometimes use chemo along with radiotherapy and hormone therapy. They usually start chemotherapy up to three months after starting hormone therapy.

Chemotherapy can slow the growth of cancer cells, give relief from symptoms, and prolong the lives of men with advanced prostate cancer.

In men with stage 4 prostate cancer, hormone therapy is usually recommended alone, but it can be combined with chemotherapy. Chemo may also be used after radiation therapy or, rarely, after surgery.

Chemotherapy shrinks the cancer cells and can even cause them to disappear. Even if they do not cause total destruction of the cancer cells, they are able to give significant symptomatic relief.

Chemotherapy drugs used to treat prostate cancer

Some of the chemo drugs used to treat prostate cancer include:

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

Only one of these drugs is used at a time.

Docetaxel

Docetaxel (Taxotere) is the first drug of choice and is combined with the steroid, prednisolone. If this does not produce the expected results, cabazitaxel is often the next chemo drug of choice.

However, Docetaxel chemotherapy was demonstrated to improve survival of men with advanced Hormone-Refractory Prostate Cancer (HRPC) and is today the basis of chemotherapy often utilized in combination with prednisone or estramustine (Emcyt).

Six cycles of docetaxel along with hormone therapy (androgen deprivation therapy) was found to be an appropriate option for men with metastatic prostate cancer

These drugs improve the survival period, slow down the growth of cancer and reduce the symptoms. Though they do not cure cancer, they significantly improve the quality of life of the patient.

How is chemotherapy given?

Doctors give chemotherapy in sessions or cycles of treatment followed by a revival period. The entire treatment usually lasts three to six months, depending on the type of chemotherapy drug used.

You’ll be given treatment every three weeks and your doctor will monitor you after each session to determine if your treatment is working and if you have too many side effects.

Chemotherapy is typically given through a vein in a chemotherapy clinic or in a hospital setting. At times, the oncologist may advise an overnight stay in the hospital. Some chemo drugs, such as estramustine, are given orally as a pill (oral chemotherapy).

Chemotherapy is usually given through an I.V. drip (intravenous infusion) into a vein in your arm. The infusion normally takes about one hour and the doctor removes the tube (I.V. cannula) from your arm before you go home.

Sometimes, sturdier central venous catheters (CVCs), central venous access devices (CVADs), or central lines are required to be used to administer medicines, blood products, nutrients, or fluids right into your blood.

Different kinds of central venous catheters are available. The most common types are the port and the peripherally inserted central catheter, also called a PICC line.

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.

Possible side effects

Chemotherapy drugs work in cancer because they destroy the fast-growing cancer cells. But, this action is not limited to the cancer cells only. They also affect the normal fast-growing cells in the body, which give rise to side effects.

Such healthy fast-growing cells include those in the bone marrow (where new blood cells are made), the membranes in the mouth, the lining of the digestive tract, and the hair follicles.

However, the damaged healthy cells will be replaced and most of these side effects are only temporary till the treatment lasts.

The nature of the side effects also depends on the type of the chemo drug used and the duration for which it is given.

Some common side effects include:

  • Hair loss all over the body including eyelash, eyebrow, armpit, pubic hair, and other body hair
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea
  • Increased chance of recurrent  infections ( due to low WBC count)
  • Easy bruising or bleeding (due to low blood platelet count)
  • Fatigue caused by anemia (due to low RBC count)
  • Infertility, which can be permanent

These side effects last for the duration of treatment and go away when the treatment stops.

Survival rates for prostate cancer

With reference to survival rates, men with prostate cancer can be divided into two groups:

  • Men with prostate cancer that is restricted to the prostate have a high long-term survival rate for their prostate cancer. Almost all will survive for more than five years – and some may live well beyond.
  • Men whose prostate cancer has spread to other areas, such as the bones may need treatment that is more aggressive. Only about one-third will survive their prostate cancer for more than five years.

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