Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. In advanced prostate cancer, it’s used to treat cancer that’s no longer being controlled by hormonal therapy.
Chemotherapy aims to shrink and control the cancer, and relieve symptoms, with the aim of prolonging a good quality of life. Chemotherapy drugs are usually given by injection into a vein (intravenously).
The most commonly used chemotherapy drug to treat prostate cancer is docetaxel (Taxotere®). Other drugs that may be used are:
Cabazitaxel is a new chemotherapy drug. It may be given to men who have previously had chemotherapy with docetaxel. It’s licensed for use in the UK but has not been approved by NICE or the SMC, so it may not be widely available on the NHS.
Side effects of chemotherapy
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others experience more. The main side effects are described here, along with some of the ways they can be reduced.
Low resistance to infection (neutropenia)
Chemotherapy can reduce the number of white blood cells in the blood, which help to fight infection. White blood cells are produced by the bone marrow. If your number of white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia. This begins a few days after treatment. Your number of white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising or bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Low number of red blood cells (anaemia)
Chemotherapy can reduce your number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms, as you may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Chemotherapy can make you feel or be sick. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn’t controlled, or if it continues, tell your doctor. They can prescribe a different anti-sickness drug that may be more effective for you.
Your mouth may become sore or dry, or you may notice small ulcers in your mouth during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Some people find sucking on ice soothing if they do get a sore mouth. Tell your nurse or doctor if you have these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Loss of appetite
Some people lose their appetite while having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve, you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
This is a common side effect of some chemotherapy drugs. Some men find this distressing. However, there are many ways of covering up hair loss, including wigs or hats. If you do lose your hair, it should start to grow back within about 3–6 months of finishing treatment.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after. It’s important to try to pace yourself and to get as much rest as you need. Try to balance rest with some gentle exercise such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Chemotherapy can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It’s important to drink plenty of fluids if you have diarrhoea.
Our section on chemotherapy discusses the treatment and its side effects in more detail.
Although side effects may be hard to deal with at the time, they will gradually disappear once your treatment finishes.
Advantages and disadvantages of chemotherapy
Chemotherapy may help to control the cancer and relieve symptoms if hormonal therapies are no longer working.
Chemotherapy can cause unpleasant side effects.