Some men diagnosed with advanced prostate cancer may be candidates for chemotherapy as part of their treatment, which is typically given to the patient by a medical oncologist.
Chemotherapy is a type of treatment for the whole body (ie. systemic therapy) given through an intravenous (IV) infusion into one of the patient’s big veins (either in the arm or under the collar bone).
Before beginning chemotherapy, a patient will meet with their medical oncologist to review their medical record, undergo a physical examination, and undergo any necessary lab testing and imaging studies. Your medical oncologist will also tell you about your chemotherapy treatment schedule. Generally, for prostate cancer, these treatments occur every 3 weeks with each treatment taking a couple of hours.
In addition to chemotherapy, your medical oncologist may include a steroid pill (ie. prednisone) and/or an injection to increase your blood counts to decrease the risk of infection. The two most common types of chemotherapy used in prostate cancer are docetaxel and cabazitaxel.
Docetaxel
Docetaxel is given to men with advanced prostate cancer with the following two indications:
1) metastatic hormone sensitive prostate cancer (mHSPC; disease that has spread outside of the prostate gland that has not been previously treated with systemic therapy/hormone therapy),
2) metastatic castration resistant prostate cancer (mCRPC; disease that has spread outside of the prostate gland that is still growing despite receiving hormone therapy).
Docetaxel was first introduced in men with mCRPC in 2004 when it showed a 24% survival benefit compared to men receiving another medication called mitoxantrone. Since then, docetaxel is now also used in men with mHSPC. In 2015, the CHAARTED trial showed that men receiving docetaxel plus hormone therapy had a 39% survival benefit compared to men receiving hormone therapy alone. A similar study in the United Kingdom (the STAMPEDE trial) also showed that men receiving docetaxel plus hormone therapy had a 22% survival benefit compared to men receiving hormone therapy alone.
Importantly, these results have continued to show a survival benefit with longer follow-up. Based on these studies, and guidelines that have been written as a result of them, many men with advanced prostate cancer will be offered docetaxel chemotherapy as part of their treatment plan.
Cabazitaxel
Cabazitaxel is another type of chemotherapy that is offered to men with advanced prostate cancer, but is not used as commonly as docetaxel.
In 2010, cabazitaxel was tested versus mitoxantrone in men with mCRPC who had worsening of their prostate cancer after previously receiving docetaxel. In this trial, men that received cabazitaxel had a 30% improvement in survival and a 26% improvement in disease progression compared to men receiving mitoxantrone.
More recently, in 2019, among men with mCRPC that had previously received docetaxel and an androgen-signaling-targeted inhibitor (a strong hormonal therapy), cabazitaxel improved imaging-based progression or death by 46% compared to patients receiving another androgen-signaling-targeted inhibitor. Additionally, cabazitaxel also improved survival by 36% in these patients. Thus, while cabazitaxel has been tested as the first chemotherapy to be used in patients with prostate cancer, today, it is typically used for patients who have already received docetaxel chemotherapy (and typically other treatments as well).
Each type of chemotherapy may have unique side effects depending on a patient’s health and age. However, the most common side effects of chemotherapy include fatigue, nausea, vomiting, hair-loss, neutropenia (low count of blood cells that fight infection), tinnitus (ringing in the ears in the absence of an external source), and neuropathy (ie. muscle weakness, cramps, numbness, loss of sensation in the extremities, loss of balance, etc). Your medical oncologist will go into more details regarding the individual risks of these side-effects when discussing the pros and cons of chemotherapy.
Prior to starting chemotherapy, it is important to prepare for side effects by eating well and exercising regularly, as well as making a caregiver plan (if necessary), and making necessary adjustments to your work schedule during treatment and recovery.