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Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or taken by mouth to reach cancer cells in most parts of the body.

When is chemotherapy used?

Chemo isn’t part of the treatment for most men with prostate cancer, but it can be used to treat advanced prostate cancer, especially if there is a lot of cancer outside the prostate gland. It can be used along with hormone therapy, or by itself if hormone therapy is no longer working.

Chemo is not a standard treatment for early prostate cancer.

Chemo drugs used to treat prostate cancer

For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:

• Docetaxel
• Cabazitaxel
• Mitoxantrone
• Estramustine
• Carboplatin

Most often, docetaxel is the first chemo drug given. It is typically combined with a steroid drug, such as prednisone or dexamethasone. If docetaxel doesn’t work (or stops working), cabazitaxel is often the next chemo drug tried (along with a steroid), although there may be other treatment options as well.

Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may shrink the cancer or slow its growth, and they may also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.

Other chemo drugs are being studied for use in prostate cancer treatment as well.

How is chemotherapy given?

Chemo drugs for prostate cancer are typically given into a vein (IV) as an infusion over a certain period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.

Sometimes, a slightly larger and sturdier IV might be put into a vein to give chemo. These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing. Many kinds of CVCs are available. The most common types are the port and the PICC line.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often about 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

How long you’ll get chemo depends on how well it’s working and what side effects you have.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Some common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects usually go away once treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to prevent or reduce nausea and vomiting.

Along with the risks above, some side effects are seen more often with certain chemo drugs. For example:

• Docetaxel and cabazitaxel sometimes cause severe allergic reactions. Medicines are given before each treatment to help prevent this. These drugs can also damage nerves (known as peripheral neuropathy), which can cause numbness, tingling, or burning sensations in the hands or feet.
• Mitoxantrone can, very rarely, cause leukemia several years later.
• Estramustine carries an increased risk of blood clots.

If you notice any side effects while getting chemo, report them to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced, or treatment may need to be delayed or stopped to prevent the effects from getting worse.