Overview

Chemotherapy uses anti-cancer drugs to kill cancer cells or slow their growth. Treatment also affects healthy cells; whereas healthy cells have the capacity to regenerate, cancerous cells do not.

Chemotherapy uses anti-cancer drugs to kill cancer cells or slow their growth. It is usually given when the prostate cancer is recurrent or metastatic or if the cancer is no longer responding to hormone therapy.

Chemotherapy is usually a systemic treatment. This means that drugs travel through the bloodstream to reach and destroy cancer cells throughout the body, including those that may have become detached from the primary tumor in the prostate.

Procedures

Chemotherapy medications can be given intravenously (into a vein), through an intravenous (IV) tube, or by using a syringe as an intramuscular (into the muscle) or subcutaneous (under the skin) injection. Chemotherapy drugs can also be given orally as a pill or liquid.

The procedure used to give you your drugs depends on the type of cancer and chemotherapy. You may receive your treatment in a hospital, clinic, doctor’s office, or at home.

Is it for you

Because chemotherapy targets fast-growing cancer cells, it is not usually recommended for men in the early stages of prostate cancer when it is still growing slowly.

Chemotherapy is most often used to treat men with prostate cancer that is recurrent or has spread to another part of your body following hormone therapy.

Chemotherapy plays an important role in the treatment of prostate cancers that are no longer responding to hormone therapy (hormone-resistant, castration-resistant or androgen-independent).

Research protocols are ongoing to determine the drug’s potential in combination with other treatments such as radical prostatectomy or radiation therapy for patients with more aggressive cancers.

Reasons for choosing chemotherapy

Chemotherapy can help men with prostate cancer to:

• slow the spread of cancer
• prolong your life
• relieve pain or delay late-stage symptoms

Types of chemotherapies

The chemotherapeutic agents most commonly used in the treatment of metastatic prostate cancer are:

Docetaxel (used in combination with prednisone* or prednisolone*) has been shown to prolong survival when used to treat hormone‑resistant cancer.

Cabazitaxel is an anti‑cancer drug used with prednisone to treat patients with prostate cancer that has spread beyond the prostate and that has been previously treated with docetaxel.

Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemotherapeutic drugs. They can slow the growth of cancer and also reduce symptoms, resulting in a better quality of life.

Castration-resistant prostate cancer

Without detectable metastasis

Castration-resistant prostate cancer without detectable metastasis is currently one of the most studied area in prostate cancer research.

In recent years, some new generation anti-hormonal drugs in the form of tablets – apalutamide (Erleada), enzalutamide (Xtandi) or darolutamide (Nubeqa) – have been shown to be effective in patients with castration-resistant prostate cancer, without metastases, but with a rapid elevation of their PSA. Your doctor may offer you one of these options if your cancer is at high risk of progression.

If you are at this stage of the disease, you should talk to your doctor about the possibility of participating in a research protocol that will give you access to these new forms of therapy.

With detectable metastasis

Metastatic castration-resistant prostate cancer is when the cancer has spread to parts of the body other than the prostate, and it is able to grow and spread even though drugs or other treatments to lower the amount of male sex hormones are being used to manage it.

In this type of cancer, diagnostic exams such as bone and CT scans can detect metastasis. Sadly, since curing the disease is no longer possible at this stage, prolonging life and preserving the patient’s quality of life becomes the number one priority.

The doctor attempts to delay complications due to metastasis — pain, bone fractures, weight loss, loss of mobility, etc. — for as long as possible. As soon as the cancer reaches the castration-resistant stage and metastasis is detectable, hormone therapy is no longer enough on its own. Chemotherapy improves the general condition of the patient who begins to be very affected by the disease. Furthermore, while older hormonal treatments are still useful and should continue to be used, the addition of new generation of hormonal agents, such as apalutamide (Erleada), enzalutamide (Xtandi) and abiraterone acetate (Zytiga), offers substantial benefits to patients.

In addition to your cancer treatment, relieving symptoms and side effects is an important part of metastatic cancer care and treatment. Bone pain relievers as well as treatments to strengthen the bones, for example, zoledronic acid (Zometa) or denosumab (Xgeva) and even palliative radiotherapy are prescribed. Dietary supplements (of the Ensure type) and blood transfusions in case of anemia are also useful.

You could also consider participating in a research protocol to benefit from new forms of therapy.

Advantages and limitations

While this treatment can help to relieve your symptoms, it is not a cure. However, as it affects your entire body, it can help to slow the spread of your cancer no matter where the cancer has spread.

Advantages of chemotherapy

• Chemotherapy can slow the spread of your cancer.
• Chemotherapy can treat prostate cancer regardless of where it has spread in your body.
• Chemotherapy can be used in combination with other treatments.
• Chemotherapy can relieve late stage cancer pain.
• Chemotherapy can prolong your life.

Limitations of chemotherapy

• Chemotherapy can cause side effects that may strongly impact your daily life.
• Certain side effects will persist for as long as you undergo chemotherapy.

Risks and complications

Side effects will vary depending on the type of drug administered. The following side effects are common with most types of chemotherapy:

• Gastro-intestinal problems such as nausea, vomiting, and diarrhea.
• Fatigue and anemia
• Total or partial hair loss
• Skin sensitivity
• Vulnerability to infection (most often chest, mouth, throat, and urinary tract infections).
• Changes in nail texture or colour
• Infertility

Some side effects can be treated with other drugs, while other side effects will persist for as long as you undergo chemotherapy.

What to expect

At home

What you may suffer or experience

While chemotherapy kills cancer cells, it can also damage healthy cells. Your body’s cells and tissues do not all react to chemotherapy in the same way.

Side effects can manifest at any point during your chemotherapy. Some side effects occur during treatment while others develop immediately after or a few days or even several weeks later. Most side effects will gradually fade away as your healthy cells recover from the effect of the chemotherapeutic agents.

It is important to inform your healthcare team of any side effects you may experience. Your doctor will grade (measure) how severe the side effects are. If side effects are serious, you may need to adjust your dose, treatment length, or drug combination.

Side effects

Chemotherapy is sometimes referred to as the treatment that may make you feel sick in order to get better. Most people fear its side effects, partially because people only hear about the most extreme side effects.

Keep in mind that not everyone experiences serious side effects and that any discomfort is usually temporary.

Side effects vary in type and severity from person to person and from medication to medication. Damage to normal, healthy cells is the cause of side effects. To learn more, For more information, see our section on side effects or visit chemoready.ca, a specialized website on the subject.

Chemotherapy drugs

Docetaxel (Taxotere): Side effects associated with the use of docetaxel include neutropenia (decreased white blood cells), fatigue, hair loss, diarrhea, neuropathy (nervous disorder), limb edema (swelling of the tissues due to water retention) and nail dystrophy.

Cabazitaxel (Jevtana): Side effects related to its use include fatigue, diarrhea, hematuria (blood in the urine), anemia, neutropenia (decreased white blood cells), hair loss and limb edema (swelling of the tissues due to water retention)

Hormone therapy drugs used in combination

Abiratérone (Zitiga): Presents more specific side effects such as hypertension, water retention and swelling, fatigue, urinary infection, cardiac arrhythmia, and liver damage.

Enzatulamide (Xtandi): Can cause headaches, hot flashes, hypertension, back pain, respiratory tract infections, anxiety, diarrhea, fatigue, epileptic seizures, blood in the urine and swelling.

Some men may experience all of the side effects listed above, while others will experience only a few or none at all. Other side effects may occur.

Increased risk of infection

You will be asked to monitor your temperature regularly and notify your doctor if you notice sores that do not heal. The increased risk is due to the decline in white blood cells (neutropenia).

What you can do…

• Wash hands often, especially before eating and after using the washroom. Carry a small bottle of hand sanitizer to clean your hands when water is not available.
• Clean any cut at once with warm water, soap and antiseptic.
• Avoid crowds and people with infections.
• Cut your nails carefully to avoid cuts.
• Use an electric razor for shaving.
• Use gloves for protection when doing activities that may cause injury to the skin.
• Avoid constipation.
• Thoroughly wash or peel uncooked fruits/vegetables.
• Don’t eat undercooked meat or poultry.
• Don’t clean cat litter boxes or bird cages. Avoid all contact with animal urine and stool.

Fatigue

If you experience fatigue, take care of yourself both emotionally and physically. Limit the number of visitors or length of visits and rest several times during the day.

What you can do…

• Physical activity can help cope with fatigue.
• Try to conserve energy by delegating as many tasks as possible or by making them easier. For example, sit down to cook your meals or have someone drive you to your appointments.

Anemia

Chemotherapy causes anemia in some men. Your healthcare team will check to see if you have anemia every time you get a blood test. hen your red blood cell count is too low, your body does not get enough oxygen to do its job properly. This can make you feel unusually tired, extremely fatigued, dizzy or short of breath. Talk to your healthcare team if you notice any of these symptoms.

What you can do…

• Iron supplementation is provided by means of tablets or directly intravenously, depending on the tolerance and the circumstances.
• The level of iron can only be improved through diet when iron deficiency is the consequence of an unreasonable diet. Eat a well-balanced diet. Follow your doctor and nurse’s instructions for a diet adapted to your situation and, if recommended, for nutritional supplements.

Gastrointestinal problems

Nausea and vomiting can occur one to three hours after receiving chemotherapy or even two to four days after treatment. Some people experience nausea and vomiting even before starting their next cycle of chemotherapy. This is known as anticipatory nausea and vomiting. For the majority of men, medication is available that can help control these side effects.

Diarrhea can occur soon after chemotherapy starts and can last for up to 2 weeks after the treatment has ended.

What you can do…

• Talk to your care team. Medications may be prescribed
• Ask to meet a nutritionist if you have not already done so
• Practice physical activity or relaxation (yoga, meditation) between treatments

Mouth sores

Regular and thorough oral hygiene can help prevent pain and reduce infection. Your healthcare team will provide guidelines to follow regarding the frequency of cleaning and rinsing of the oral cavity and what products to use. Analgesics or special oral solutions may be needed to relieve pain. A special mouthwash can help minimize mouth sores.

What you can do…

• Avoid tart, salty, acidic or spicy foods.
• Drink lots of fluids. This will help the sores heal.
• Remove dentures frequently to give your gums a rest.
• Keep your mouth moist. If your mouth is dry, suck a popsicle, ice cube or a hard candy.

Changes to nails

Nail changes are common during chemotherapy and can affect both fingernails and toenails. Your nails can become black, yellow, brittle, cracked, striated, or partially separated from the nail bed. Darkening of the nails usually fades a few months after chemotherapy ends.

What you can do…

• Using cuticle cream instead of tearing or cutting nail cuticles.
• Protecting nails by wearing gloves when washing the dishes, gardening, or doing other household chores.

Most men do not get late side effects from chemotherapy; however, some men may experience swelling or tingling in their hands and feet.

For more information, see our section on Nutrition, Living with cancer or visit chemoready.ca, a specialized website on the subject.

Medical follow-up

Team up with you’re your health care team

Follow-up care is important for both you and your healthcare team.

It helps your healthcare team to monitor your progress and see how well you are recovering from any side effects caused by your chemotherapy treatment. Be sure to keep track of any side effects you may be experiencing. It helps to keep a journal.

Follow-up appointments give you a chance to discuss how you’re feeling. Feel free to also discuss how you felt about having cancer. You can ask questions about your care and anything that you should watch for in the future. You may also want to talk about making healthy changes to your lifestyle or ask about support groups if you do not belong to one already.

Your healthcare team

Your healthcare team will outline the details of your follow-up plan. As well as consultations with your healthcare team, follow-up care may include a physical exam, blood tests and other imaging exams. These tests may be similar to those you had for diagnosis.

The schedule of follow-up visits is different for each person. You might be seen more often in the first year after treatment, and less often after that. Your follow-up care may be managed by your family doctor or your oncologist or haematologist. This may depend on your type of cancer and how successful the chemotherapy was in treating it.

Your follow-up care may be entrusted to your family doctor, oncologist, or hematologist depending on your cancer type and the success of your chemotherapy treatment.

Suggestions and advice

Questions for the medical team

Getting the answers you need means being prepared. Make a list of questions to ask before you meet with your doctor or nurse. Making a list of questions before your doctor’s appointment can be a helpful way to keep track of everything that is on your mind.

• List the most important questions first.
• Take a friend or relative with you.
• Remember that this is not your only chance to ask questions.
• Try to accept that medicine does not always have a definitive answer.