When is chemotherapy used?

Chemotherapy has traditionally been used as a treatment when all second- and third-line therapies have failed. However, results of the STAMPEDE trial released in 2015 have shown that chemotherapy is most effective when used early for men with metastatic and men with high-risk non-metastatic cancer in conjunction with standard first-line Hormone treatment. This also has the advantage that the patient may be fitter and more able to withstand the side effects of chemotherapy treatment.

Commonly, you may be recommended chemotherapy when standard Hormone treatments have become ineffective and the more advanced drugs such as abiraterone and/or enzalutamide have not worked. There is no ‘right time’ to start chemotherapy. The treatment will affect your quality of life for 6 months. On the other hand, delaying having chemotherapy until you are seriously ill and unfit may mean worse side effects. It is best to be as strong and as fit as you can beforehand.The ‘early chemotherapy’ option should be discussed with your oncologist in detail following your diagnosis and full staging of the disease.

Prostate Cancer chemotherapy is usually administered with the ‘first-line’ drug docetaxel (Taxotere®), which is always used in combination with a cortico-steroid such as prednisolone, an anti-inflammatory that helps reduce nausea.

What can the patient expect?

Docetaxel is administered as a one-hour infusion every three weeks, usually for up to ten infusions, depending on the patient’s tolerance and response. It acts like a poison to prostate cancer cells, causing cell death. Prednisolone given at the same time aims to reduce inflammation and pain. A patient’s hormone treatment may be continued in parallel. In trials, 50% of patients after chemotherapy achieved a 50% reduction in PSA on average, though many men achieve much lower PSAs. As prostate cancer seems to present itself in a variety of forms, every patient’s experience will be different. When docetaxel is successful, patients can expect their lower PSA to remain for several months or even some years.

Side effects of chemotherapy

Because docetaxel is toxic, and not specifically targeted at prostate cancer cells, it can and does damage normal cells as well. The number of side effects listed is quite large, common ones being temporary hair loss, damage to fingernails and toenails, and bone marrow. Patients’ experiences vary. A lucky few are fairly free of side effects; in others, they can be quite severe. Aches and pains, and extreme fatigue, particularly in the first week after the infusion, are quite common. Because of the damage to bone marrow, red blood cells can be depleted, leading to anaemia; white blood cells are also reduced, which means that the immune system is compromised.

Other side effects can include loss of appetite, feeling sick and mouth ulcers. Any infections during the chemotherapy cycle have to be dealt with immediately and may even interrupt the treatment cycle; in this event you must contact your GP straight away.

A newer drug building on the success of docetaxel is cabazitaxel. This is a ‘second generation’ docetaxel or ‘second-line’ treatment. It has been approved by NICE for patients who have previously been given docetaxel. The side effects are slightly different, in particular, cabazitaxel does not tend to cause problems with numbness and tingling, that is common with docetaxel.