Prostate Cancer

Chemotherapy For Prostate Cancer: Benefits and Risks

Prostate cancer remains a significant health care issue, with more than 1 million cases diagnosed in 2018.

It often grows slowly that most men do not need immediate clinical intervention. Generally, treatment decisions are based on whether prostate cancer is localized, locally advanced, or metastatic.

Localized or locally advanced disease are usually treated with surgery or radiation therapy. However, a significant proportion of patients are diagnosed with metastatic prostate cancer or progress following initial treatments. In advanced stages, surgery and radiation therapy are no longer useful, which requires other treatment options.

Chemotherapy drugs kill cancer cells in any part of the body. Although it cannot cure the disease, chemotherapy can control cancer growth and reduce symptoms.

Unfortunately, chemotherapy drugs have potential side effects, such as tiredness, anemia, increased risk of infections, and bowel complications. Here, we explore the use of chemotherapy drugs in the treatment of prostate cancer. We offer answers to common questions to help you consider the best treatment for your cancer.

What is chemotherapy

Cancer is a condition where cells grow uncontrollably. Thus, therapy aims to remove or kill the cancer cells before they overwhelm the body. Many procedures are available to achieve this aim based on cancer’s primary location and the mutation that caused the cancerous transformation.

Chemotherapy is one such approach that involves anti-cancer drugs to stop or slow the growth of cancer cells. These drugs exploit the fact that cancer cells grow and divide quickly. They inhibit the division of cancer cells, which prevents them from making more cancer cells and spreading in the body. 

Targeting this critical vulnerability of cancer cells reduces the impact of chemotherapy on normal healthy cells. However, the human body has several fast-growing healthy cells, including cells found in the skin, intestines, and bone marrow. The impact of chemotherapy treatment on these healthy, fast-growing cells is the cause of this type of treatment’s side effects.

Docetaxel is the standard chemotherapy for prostate cancer, usually paired with a steroid drug (prednisone). If docetaxel fails, other chemotherapy drugs, including Cabazitaxel and carboplatin, are usually given, one at a time. Clinical trials have shown that these drugs help slow cancer growth and prostate cancer symptoms.

When is chemotherapy used?

The use of chemotherapy in prostate cancer depends on the disease stage and spread to other parts of the body. Other factors, such as the severity of current symptoms and previous treatments, are likely to influence your options.

Your doctor may recommend chemotherapy for one of the cases below:

  1. Before other treatments such as surgery and radiation, to help shrink the tumor, meet the procedure’s clinical requirements, and improve the cancer treatment outcome. 

  2. After other treatments to help target and kill any remaining cancerous cells, a combination of therapy in this manner improves treatment durability by reducing the risk of cancer recurrence.

  3. As the only therapy, chemo is recommended if other treatments are not suitable or fail.

  4. As a therapy for metastatic or recurred prostate cancer.

The goal of chemotherapy in the above cases can be divided into three broad categories, including:

  • Curative: Rarely, locally advanced prostate cancer is treated with chemotherapy, usually combined surgery, radiotherapy, or hormone therapy. This combinatory therapy may help cure the disease. 

  • Control: When prostate cancer has spread to other parts of the body, treatment aims to kill and slow cancer cells’ growth anywhere in the body. Here, chemotherapy combined with hormone therapy is the standard clinical care for advanced prostate cancer. This approach helps slow down the spread and progression of the disease.

  • Palliative chemotherapy: In other cases, such as metastatic castration-resistant prostate cancer, chemotherapy is used to improve and delay symptoms.

It is noteworthy that suitability for chemotherapy depends on other clinical factors. For instance, chemotherapy causes side effects that may be hard to deal with if the patient has other health conditions.  

What does treatment involve?

Your doctor will help you decide on the most suitable treatment for your prostate cancer. After careful clinical assessment, your doctor may recommend chemotherapy in a curative, control, or palliative regime. It is essential to balance the side effects of a chemotherapy regimen against the benefits. The benefits and side effects of chemotherapy are detailed in the next section to help with your discussions. 

If you decide to proceed with chemotherapy, your medical team will first discuss your treatment plan with you. This clinical plan will explain the exact chemotherapy agent you will receive, the approach for managing treatment side effects, and any diagnostic tests you will get before and after treatment. 

The treatment cycles and dosage will depend on the drug and the clinical aim, as discussed above. 

Before treatment

Usually, you would undergo a battery of blood tests to ensure your continued suitability for the treatment. As we discussed before, this safety step is vital because chemotherapy can cause side effects that are difficult to manage in the presence of other medical conditions or poor health state. 

During the treatment

Most chemotherapy medicine for prostate cancer are given intravenously into a vein in your arm. Depending on the prescribed dose, the treatment may last for an hour, and you will be able to go home at the end of the treatment. 

Drugs

There are two main chemotherapy drugs for prostate cancer, including Docetaxel and Cabazitaxel.

  • Docetaxel: For decades, androgen deprivation therapy was the standard of care for metastatic prostate cancer. However, progression to metastatic castration-resistant develops inevitably develops, requiring new treatment options. In 2004, treatment with docetaxel became the primary therapy for treating metastatic castration-resistant prostate (Berthold et al., 2008). More recent clinical trials involving metastatic and non-metastatic prostate cancer patients demonstrated that docetaxel, combined with standard care, improved patients’ overall survival (James and Mason, 2015). 

  • Cabazitaxel: Despite the improvements in overall survival conferred by docetaxel, most of the patients eventually experience disease relapse. Drug resistance causes the progression to this stage of the disease is attributed to drug resistance, which requires new drugs. Cabazitaxel is currently the most common second-line chemotherapy drug in these cases. Several clinical trials demonstrated the clinical anti-tumor activity of Cabazitaxel combined with the steroid prednisone. Cabazitaxel improves the overall survival in patients with metastatic castration-resistant prostate cancer who progressed after docetaxel-based therapy (De Bono et al., 2010).

What happens afterwards?

Most men will continue with their routine during and after chemotherapy with any of the drugs mentioned above. Your doctor will continue to monitor your cancer to ensure treatment response and side effects. A chemo drug may interact with other medications and medical conditions; hence it is crucial to inform your doctor about any new treatments. Side effects are common in chemotherapy, discussed below, which may require additional treatment and monitoring.

What are the advantages and disadvantages of chemotherapy?

Chemotherapy medication helps to treat prostate cancer that has spread to other parts of the body. Removal of the prostate gland by surgery or radiation therapy is the best treatment for localized prostate cancer.

Though these localized treatments can be curative by targeting the prostate gland, they are ineffective in advanced or metastatic prostate cancer. Systemic treatment using chemotherapy drugs is beneficial in advanced prostate cancer because they can target cancer cells anywhere in the body. However, chemotherapy often causes side effects.

Advantages of chemotherapy

  • Chemotherapy drugs destroy cancer cells anywhere in the body to slow cancer spread and increase survival outcomes. 

  • Chemotherapy before curative therapies may shrink cancer enough for surgery or radiotherapy to be more effective.

  • Combination therapy with chemotherapy may reduce the risk of treatment relapse.

What are the side effects of chemotherapy?

The main concern with chemotherapy is the side effects that develop due to the drugs killing healthy cells. Chemotherapy drugs work by killing fast-growing cells. Thus, it can also affect some healthy cells that multiply rapidly, especially cells in the bone marrow, lining of the mouth, the bowel, hair follicles, and other skin structures.

Some of the common side effects experienced by prostate cancer patients receiving chemotherapy are as follows:

  • Infections: The effect of chemotherapy on the bone marrow, “the production house of blood cells,” may reduce the body’s ability to fight infections through reducing white blood cells. It is crucial to seek immediate medical attention if you suspect an infection because it could be fatal.

  • Tiredness and shortness of breath: Like the case of infection, chemotherapy may reduce the number of red blood cells in circulation, reducing available oxygen. It is essential to speak to your doctor about these symptoms before your next treatment cycle. It is noteworthy that sometimes tiredness develops from cancer, instead of the treatment with chemotherapy.

  • Bleeding and bruising: These drugs can also reduce the number of platelets in your blood. Because of platelets’ critical role in blood clot formation, chemotherapy may cause an increased risk of bleeding and bruising.

  • Nausea and vomiting: Chemotherapy may increase the risk of nausea and vomiting. The rate of this side effect is reasonably similar to other medications.

  • Loss of appetite: Chemotherapy may affect your appetite, either through the effect of nausea and vomiting or general loss of taste. Speak to your doctor about the nutritional regime to help you with this side effect.

  • Mouth problems: Chemotherapy drugs may increase the risk of mouth sores and inflamed gums. Your medical team will help manage mouth-related side effects, including gently brushing and eating soft and moist foods.

  • Hair loss, sensitive skin, and nail discoloration: Hair, nail, and skin problems are common in patients treated with chemotherapy drugs. These skin and hair problems will affect patients differently, ranging from mild to severe effects. 

  • Bowel problems: Another area affected by many chemotherapy drugs is changes in bowel movement. Some chemotherapy drugs may cause diarrhea, while others cause constipation. Bowel side effects are usually managed with additional medications. Your doctor will help you decide the best course of action.

  • Mood changes: Some patients may experience mood changes during and after their chemotherapy. Speak to your doctor about this. There are usually support available to help you deal with mood changes.

  • Steroid specific side effects: Some men also receive steroids with their chemotherapy, which may cause indigestion, restless and swollen limbs. 

Many of these side effects will affect men differently, and most of them are temporary effects that resolve gradually after treatment. It is vital to speak to your doctor before initiating any treatment to manage these side effects.

Dealing with prostate cancer 

A prostate cancer diagnosis brings a range of psychological and physical challenges for men.

Treatment decisions are stressful due to the combined impact of prostate cancer symptoms and potential treatment side-effects. However, prostate cancer symptoms differ across individuals and depend on the stage, tumor size, and other medical conditions. 

In the early, slow-growing stages of the disease, you are unlikely to feel any pain as the tumor is not pushing against other organs around the prostate region. However, when the tumor becomes large enough, it will cause a variety of urinary symptoms. It is essential to speak to your doctor about the possible treatments for symptoms. Early therapy with surgery (radical prostatectomy) or radiotherapy may be curative and could alleviate your symptoms.

The progression to advanced metastatic prostate cancer can cause additional problems depending on the site and how quickly it is spreading. It often spreads to the bone, making them weaker and prone to fracture.

Speak to your medical team about treatment and support with pain management. In the lymph node, prostate cancer cells may block the circulation of lymph to cause swelling. The occurrence of these complications can harm your quality of life. 

Fortunately, many options are available to manage prostate cancer symptoms, with or without the treatment of underlying cancer. Following the expert advice given by your medical team will reduce the negative impact of prostate cancer on your quality of life.

Conclusion 

Chemotherapy benefits patients with advanced disease or hormone-refractory metastatic disease. Nevertheless, it is not necessarily useful for patients with localized prostate cancer, where curative surgery or radiation therapy is the current standard of care.

The side-effects of chemotherapy, coupled with the marginal improvement in median survival outcomes, remain a concern. Therefore, it would be best to speak to your doctor about chemotherapy’s benefits and complications to help you make an informed decision.

Treatment outcomes for cancers, including prostate cancer, is dependent on the disease stage, whether cancer has spread to other sites and how fast it is spreading. Chemotherapy, combined with curative surgical and radiation therapy, can treat localized and locally advanced disease.

Treatment with chemotherapy drugs alone or in combination with hormone therapy can improve symptoms and increase overall survival. However, there is no cure for metastatic prostate cancer occurring after treatment relapse.

Sources

  1. Berthold, D.R., Pond, G.R., Soban, F., De Wit, R., Eisenberger, M., Tannock, I.F., 2008.
  2. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: updated survival in the TAX 327 study. J. Clin. Oncol. 26, 242–245.
  3. De Bono, J.S., Oudard, S., Ozguroglu, M., Hansen, S., Machiels, J.-P., Kocak, I., Gravis, G., Bodrogi, I., Mackenzie, M.J., Shen, L., 2010. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer
    progressing after docetaxel treatment: a randomised open-label trial. The Lancet 376, 1147–1154.
  4. James, N., Mason, M., 2015. Docetaxel and/or zoledronic acid for hormone-naïve prostate cancer: first survival results from STAMPEDE. J Clin Oncol 33, 5001.

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