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Chemotherapy

The information on this page comes from our Tool Kit fact sheet on chemotherapy. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download and print a PDF version of this fact sheet.

This page is for men with prostate cancer and their families who would like to know more about treatment with chemotherapy. It describes how chemotherapy is used to treat prostate cancer as well as possible side effects. We hope that it will help you make decisions with your doctor about your treatment. Each hospital and specialist team will do things slightly differently so use this page as a general guide and ask your specialist team for more details about the care you will receive.

Who can have chemotherapy?

Chemotherapy uses anti-cancer (cytotoxic) drugs to kill cancer cells. It is a very common treatment for many types of cancer. In the past chemotherapy was not shown to be a very effective treatment for prostate cancer. Now, newer chemotherapy drugs are available which are sometimes helpful for men whose cancer has spread outside the prostate gland and is no longer responding to hormone therapy. Some men may be offered chemotherapy at an earlier stage of their disease as part of a clinical trial. Chemotherapy is used to help control symptoms and not to cure the prostate cancer.

Chemotherapy may not be suitable for every man. If your specialist (oncologist) thinks that you may benefit from chemotherapy they will first assess your general health. This may involve checking that your heart, lungs, liver and kidneys are working normally, as well as making sure that you are well enough to care for yourself with some occasional help. 1 This is because the side effects of chemotherapy are sometimes difficult to cope with so you need to be reasonably fit before you begin treatment.

If your doctor decides that you are suitable for chemotherapy they will then discuss the possible side effects of the drugs with you. Consider these alongside the possible benefits from the treatment before making a decision about whether to go ahead. If you are not well enough to have chemotherapy your doctor will discuss with you other treatments, such as palliative radiotherapy or pain-relieving drugs, which are likely to help control your symptoms.

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How does chemotherapy treat prostate cancer?

Chemotherapy is very good at destroying cells that are rapidly dividing, which is what cancer cells do. Some types of cancer are very sensitive to chemotherapy. The drugs will destroy the cancer cells better than other treatments such as surgery or radiotherapy. This is not true with prostate cancer. Prostate cancer is more responsive to surgery or radiotherapy. However, if cancer cells break away from the prostate tumour and travel to other parts of the body to form new tumours (metastases or secondary tumours), chemotherapy can sometimes help treat these. This is because the cancer cells travel through the blood or lymphatic system which is how chemotherapy drugs get into your system. The drugs can get to the cancer cells wherever they are in the body.

One disadvantage of this is that as well as destroying the cancer cells, the chemotherapy can also affect your healthy body tissues where cells are rapidly dividing and growing. For example, your hair follicles, bone marrow and skin. Although the damage does not usually last, it can cause side effects.

The main aims of chemotherapy treatment for prostate cancer are to help:

  • Shrink the cancer
  • Slow the growth of the cancer
  • Control symptoms such as pain
  • Improve your quality of life.

There are several chemotherapy drugs available to treat prostate cancer. The most common ones are docetaxel (Taxotere) and mitoxantrone (Novantrone). Chemotherapy drugs are sometimes given alongside other treatments such as palliative radiotherapy, bisphosphonates or pain-relieving drugs. You may also be given steroids such as prednisolone with your chemotherapy. Research has shown that using a combination of docetaxel (Taxotere) and prednisolone can help to reduce symptoms such as pain, improve quality of life and increase survival. 2

In the UK, docetaxel is now considered a standard treatment option for men with advanced prostate cancer that is no longer responding to hormone therapy. 3 Treatment involves up to ten infusions. If, during treatment, your cancer continues to grow or you have severe side effects you will need to stop treatment. If the cancer does not respond to the course of docetaxel it is not recommended that you repeat this treatment. 4 This is because there is currently no evidence to show that it will help.5

If you are unable to have docetaxel or it has not worked for you, your doctor may offer you an alternative drug. This will depend on whether you are well enough to cope with more treatment. It will also depend on whether you feel that you want to go ahead with more treatment. You may be offered further treatment as part of a clinical trial.

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What are the advantages and disadvantages?

Advantages

  • May improve your quality of life by controlling symptoms such as pain
  • No need to stay overnight in hospital. You will usually visit as a day patient.
  • May shrink or slow the growth of your cancer

Disadvantages

  • Regular hospital visits
  • Not everyone is fit enough to have the treatment
  • No guarantee that it will help control the cancer or its symptoms

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What does treatment involve?

Your doctor will plan your treatment with you. They will discuss with you which drugs you are going to have, how long the treatment will take, possible side effects and investigations that you will need before, during and after your treatment. If your chemotherapy treatment is part of a clinical trial you will be told about this in detail by your specialist doctor and research nurse.

Before treatment

Before you start treatment your doctor is likely to order blood tests to make sure that all your blood counts are within normal limits. This is important because chemotherapy can affect your blood cells. Your doctor needs to get some baseline levels to compare with future results that may differ. Depending on your general health and the specific drugs that you are having you may need to have other investigations as well.

Always let your specialist cancer team know if you are taking any other medication, including over the counter or herbal medicines or supplements. There are some supplements that can interact and be harmful when taken alongside certain chemotherapy drugs. Just because something is labelled ‘natural’ does not necessarily mean that it is safe to take with other medications.

Your doctor or nurse will tell you what your treatment involves and what to expect. It can be very hard to take all this in during one session with your medical team. It can help to write things down or make sure you have someone with you to listen and discuss things with later. You will also be given written information to take home. Be sure that you fully understand what you have been told or read about your chemotherapy treatment. If you are uncertain about anything ask your medical team to explain. There is a list of suggested questions to ask your doctor towards the end of this page.

If you are having your chemotherapy as part of a clinical trial you may need more blood tests. You will need to sign a consent form before you begin treatment.

Treatment

Most chemotherapy drugs are given as a course of up to ten infusions, depending on the type of drugs you are having. An infusion involves running a fluid containing the chemotherapy drug through a needle into a vein. This allows the drugs to enter the bloodstream and travel throughout the body.

You may have each infusion every three or four weeks. An infusion of Taxotere takes about one hour (this may differ for other chemotherapy drugs). You may need to see the doctor and have blood tests before your treatment begins so this will increase the time you spend at the hospital. If your blood count is not high enough to cope with a cycle of treatment your doctor may decide to reduce your dose of chemotherapy or delay a cycle. Once your blood count returns to normal you can continue with your treatment.

You will also be given steroid tablets to take at home each day. If you have any questions about your treatment and its side effects, contact your medical team for advice. You will be given phone numbers of who to contact at your first appointment. This will include an after hours contact. Be sure to call if you have any concerns (even if you think they are trivial) especially if you have persistent or severe side effects.

It is perfectly safe to be around other people, including children and pregnant women, when you are having chemotherapy. But you will need to avoid contact with people who have infections. This is because your ability to fight infections (your immunity) is not as strong as usual at certain times during each chemotherapy cycle. You are most at risk between seven and 14 days after your treatment. If you think that you have a fever or infection then it is important to contact the hospital for advice.

You should not have any immunisations with live vaccines during your chemotherapy or for six months after. But it is safe to be around others who have had these types of vaccines. Your doctor or nurse will discuss which vaccines these might be and any details you will need if necessary. It is always best to check with your doctor before having a vaccination.

What happens after treatment finishes?

Your GP or specialist will monitor your progress. They will measure your prostate specific antigen (PSA) levels regularly (usually every three months) and keep an eye on any other symptoms. In most cases successful treatment of the cancer depends on lowering the PSA or an improvement in symptoms, such as reduced pain. If you have symptoms in between having your check ups it is important to report them to your doctor as soon as possible. In many situations they will be able to help reduce or control any symptoms you have.

If the cancer starts to grow again after you finish your treatment, your doctor may suggest another course of a different type of chemotherapy. However, there is no guarantee that this will help.6 This is because having several types of chemotherapy over time tends to make the cancer become resistant to all chemotherapy. If this happens your doctor will usually still be able to successfully control many of your symptoms. This may involve having radiotherapy to relieve pain caused by cancer that has spread to the bones or bisphosphonate drugs to help control and prevent bone problems.

When trying to decide which treatment to have in the advanced stages of your cancer, it is important to look at the benefits and risks of each treatment. Having more treatment may involve more hospital visits, tests and side effects. If these outweigh the benefits then you may want to think carefully about what you have. Everyone is different and will have their own reasons for stopping or continuing with treatment.

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What are the side effects?

Because chemotherapy attacks cells that are dividing quickly it not only affects the cancer cells but also other healthy cells in the body that divide rapidly. This includes the cells in the lining of the mouth, intestines, hair follicles and bone marrow. Chemotherapy can harm these cells and cause side effects. Most of the side effects are temporary and your body will recover once the treatment finishes.

People react in different ways to chemotherapy. Some men may get a lot of side effects whilst others will only have a few. Most side effects can be kept under control by either taking medication or precautions where possible. The most common side effects are described here but there is no way of knowing which of these you will get, or how bad they will be. Ask your specialist about more specific side effects you can expect from the individual drugs that you are having.

Common side effects

Temporary problems with your bone marrow

Chemotherapy drugs affect how well your bone marrow functions. Your bone marrow makes white blood cells, red blood cells and platelets. White blood cells help fight infection and red blood cells carry oxygen from the lungs around the body. Platelets help your blood to clot. During chemotherapy there may be a drop in the levels of these cells. This means that you may have problems with:

  • being more at risk of getting an infection. If you get an infection you may become very sick. You should let your doctor know immediately if you develop any signs of infection such as a high temperature (above 38 degrees), feeling cold and shivery, aching muscles, headaches, cough and sore throat,
  • breathlessness and tiredness caused by too few red blood cells. If you don’t have enough red blood cells you can become anaemic. If this happens, your doctor may delay your next chemotherapy treatment to give your red blood cells time to recover. If your level of red blood cells falls very low, you may need to have a blood transfusion,
  • an increased risk of bleeding and bruising more easily due to a drop in the number of platelets in your bone marrow. You may notice you have nose bleeds or bleeding gums.

You should contact your medical team straight away if you develop any of the symptoms described above. Your doctor or nurses will discuss ways to help you prevent some of the problems that low blood counts can cause.

Fatigue (tiredness)

Many people say that fatigue can be the most difficult side effect of all to cope with. The fatigue is not just a general feeling of tiredness that goes away with a bit of rest. It can be quite overwhelming and affect how you function from day to day. It is usually more obvious towards the end of your treatment. Sometimes there is a cause for your tiredness like low levels of red blood cells. Most people find that their energy levels improve between two and six months after finishing their treatment. For some people it can last longer. If possible, regular gentle walking can help to prevent and improve tiredness. Also, listen to your body. If you feel tired, take a rest, even if it is in the middle of the day.

Hair loss

This is a temporary side effect of some chemotherapy drugs. Your hair will usually begin to grow back within three to six months of finishing treatment.

Sore mouth

Some chemotherapy drugs can make your mouth sore. You can develop ulcers which can be painful. This is because your ability to fight infection is lower than normal. Regular mouth washes and good oral hygiene are very important. Use a soft toothbrush to prevent harming your gums. Your nurses will give you information about mouth care. If your mouth gets very sore your doctor will prescribe pain-relieving drugs to help.

Loss of appetite

Chemotherapy can cause taste changes and food may taste more salty, bitter or metallic. If you do not feel like eating much it is important to drink plenty of fluids. Nutritious drinks, soups and soft food can replace meals until you feel able to eat properly again. If the smell of food is putting you off eating, ask someone to prepare and cook your meals for you if possible. Eating small regular meals rather than two large meals a day helps some people cope better. The steroids that you will be given with your chemotherapy should help with improving your appetite.

A personal experience
‘During chemotherapy, I found that most foods tasted a bit funny. A man I met, who was also having chemotherapy, advised me to avoid my favourite foods during treatment as their taste would be disappointing and may put me off them. It can be best to save your favourite meals for after your treatment has finished.’

Feeling and being sick (nausea and vomiting)

Most feelings of sickness can be kept well under control using anti-sickness drugs (anti-emetics). These are taken as injections into the vein just before each chemotherapy treatment. You can also take some anti-sickness tablets home with you. It is important to take them as directed by your doctor before meals.

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Other possible side effects

Each individual chemotherapy drug may also have its own specific side effects. For example, docetaxel causes fluid retention in about six per cent of men (six out of every 100 men). 7This means that your hands and feet may swell (oedema) and you may gain some weight. If you are having treatment with mitoxantrone, your urine may become a green/blue colour for 24 hours after each infusion. 8

You may feel a bit ‘down’ during your treatment. Some people say that they feel very sad and negative at certain times during their chemotherapy. This is natural and usually only lasts a short time. However, if you continue to feel very low in mood after your treatment is over you should talk things over with your medical team. You may have depression which is very different to just feeling sad. Do not be afraid to talk about your feelings as there are things that can be done to help treat depression.

A personal experience
‘My husband kept a daily diary with just a few lines explaining how he felt physically and mentally. It was very useful after each infusion to look back and say, ‘Oh, I’d forgotten how I felt two days after the infusion – it was just the same this time.’

Where can I get support?

As well as getting medical help to treat your cancer most men find it helps to get some emotional support as well. Feeling more in control of your emotions can help make you feel better. It is very important not to feel alone. You may find it helps to talk to your doctor or a specialised cancer nurse such as a Macmillan or Marie Curie nurse. Many of these nurses have counselling training and can help you work through some of your concerns. They also know a lot about advanced cancer and its symptoms and how to manage them. A great deal of your anxiety may go if you know your options so that you can make informed decisions about your care. If you do not already have contact with one of these nurses you can ask your GP to refer you to their services.

Questions to ask your doctor

  • What is the aim of this treatment?
  • Which drugs would be most suitable for me?
  • How long will the treatment last? How many cycles will I need?
  • What are the possible side effects of the drugs? Are any of the side effects permanent?
  • What happens if the chemotherapy drugs don’t work? Are there other treatments I can have?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Who will follow me up after my treatment finishes?

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Links

The following organisations provide further information relevant to this page.

Cancerbackup

www.cancerbackup.org.uk
For information on coping with cancer and treatment.

CancerHelp UK

www.cancerhelp.org.uk
CancerHelp is the patient information website of Cancer Research UK. It contains information on chemotherapy and living with cancer.

Macmillan Cancer Support

www.macmillan.org.uk
Practical, emotional and financial support for people with cancer, family and friends.

Marie Curie Cancer Care

www.mariecurie.org.uk
Marie Curie run hospice centres throughout the UK and provide a nursing service for patients in their own home day and night, free of charge.

National Institute for Health & Clinical Excellence (NICE)

www.nice.org.uk
NICE produce guidelines on the use of docetaxel (Taxotere) for prostate cancer.

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Reviewed by:

  • Lisa Dougherty, Nurse Consultant Intravenous therapy and Lead Chemotherapy Nurse, The Royal Marsden NHS Foundation Trust
  • Susan Forbes, Prostate Cancer Specialist Nurse, Torbay Hospital
  • Fiona Galbraith, Chemotherapy Team Leader, Oncology Kintore Unit, Falkirk and District Royal Infirmary
  • Linda Welsh, Prostate Specialist Radiographer/Clinical Research Radiographer, Torbay Hospital
  • The Prostate Cancer Charity Information Volunteers
  • The Prostate Cancer Charity Support & Information Specialist Nurses

Written by:

Annie Angle, Specialist Oncology Nurse Writer

Edited by:

The Prostate Cancer Charity Information Team

1. NICE. Technology Appraisal Guidance No. 101. Docetaxel for the treatment of hormone refractory metastatic prostate cancer. 2006.
2. Collins R, Fenwick E, Trowman R et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer. Health Technol Assess. 2007;11(2):iii-iv, xv-xviii, 1-179.
3. British Association of Urological Surgeons (BAUS) Guidelines on the management of metastatic prostate cancer. 2005.
4. NICE. Prostate cancer: diagnosis and treatment. Clinical guideline. 2008. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11924
5. NICE. Docetaxel for the treatment of hormone-refractory metastatic prostate cancer. Technology appraisal guidance No. 101. 2006.
6. Oh WK, Manola J, Babcic V, Harnam N, Kantoff PW. Response to second-line chemotherapy in patients with hormone refractory prostate cancer receiving two sequences of mitoxantrone and taxanes. Urology. 2006; 67(6):1235-40.
7. Electronic Medicines Compendium. Docetaxel. 2008. Available from http://emc.medicines.org.uk
8. Electronic Medicines Compendium. Mitoxantrone. 2008. Available from http://emc.medicines.org.uk

Page last updated: March 17th 2008