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What stage do you need chemo for prostate cancer?

There is no set time when you should start chemotherapy and it is different for every man. It's usually fine to start chemotherapy any time up to three months after starting hormone therapy. If you've already had hormone therapy, chemotherapy is usually given as a course of up to 10 sessions.

prostatecanceruk.org - Chemotherapy | Prostate Cancer UK

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What does treatment involve?

If you decide to have chemotherapy, you will be referred to an oncologist (a doctor who specialises in cancer treatments), and a chemotherapy nurse. Your doctor or nurse will discuss your treatment plan with you. They’ll explain which medicines you’ll have, what the treatment will involve and what the possible side effects may be. They’ll also tell you about any tests you’ll need before, during and after your treatment. If you start chemotherapy soon after you’ve been diagnosed, alongside hormone therapy, you will have up to six sessions (also called cycles) of treatment. There is no set time when you should start chemotherapy and it is different for every man. It’s usually fine to start chemotherapy any time up to three months after starting hormone therapy. If you’ve already had hormone therapy, chemotherapy is usually given as a course of up to 10 sessions. But this might not be the same for everyone. You’ll usually have treatment every three weeks. To begin with, your doctor will monitor you after each session to check that your treatment is working and you don’t have too many side effects.

Before each treatment session

A few days before each session you’ll have a blood test to check that the levels of different blood cells (your blood count) are in a normal range to have treatment. This is important because chemotherapy can cause the level of white blood cells, red blood cells and platelets to drop. If your white blood cell count is low, you might not be able to have your treatment as planned. White blood cells fight infection. If your white blood cell count is too low, you are at risk of getting infections which can make you very unwell. Your doctor may decide to reduce the amount (dose) of chemotherapy they give you. Or they might delay the session until your white blood cell count returns to normal. You may also be given a drug called GCSF (granulocyte colony stimulating factor) to help your body produce more white blood cells. Read about the side effects of GCSF. If your red blood cell count is low, your blood may not be able to carry enough oxygen around your body. This can make you feel tired, weak and breathless. Your doctor may offer you a blood transfusion to boost your number of red blood cells. This will be given through a drip (intravenous infusion) into a vein in your arm. You will also have blood tests to check how well your liver and kidneys are working. This is because the liver and kidneys break down the chemotherapy drugs and get rid of them from the body. If they’re not working properly, the drugs will stay in your body for longer and you could have a higher risk of side effects. Before each treatment session begins, your doctor or nurse will check how you’re feeling and how you’re dealing with any side effects.

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Your doctor might decide to stop your treatment if you have severe side effects or your cancer continues to grow. Every man responds differently to chemotherapy. Some men find the side effects difficult to deal with and decide to stop treatment. If you want to stop treatment, speak to your doctor or nurse.

During your treatment

The chemotherapy will usually be given through a drip (intravenous infusion) into a vein in your arm. Treatment normally takes about one hour and the tube (cannula) will be removed from your arm before you go home.

What chemotherapy drugs are used?

There are two main chemotherapy drugs that are used to treat prostate cancer – docetaxel and cabazitaxel.

Docetaxel

In the UK, docetaxel is the most commonly used chemotherapy for men with advanced prostate cancer. It can be used alongside hormone therapy for men who have just been diagnosed with advanced prostate cancer, and sometimes for men with locally advanced prostate cancer. It can also be used if hormone therapy has stopped working so well.

Cabazitaxel

You might be offered cabazitaxel if you have advanced prostate cancer that has stopped responding to hormone therapy and you have already had docetaxel. You may hear cabazitaxel called second-line chemotherapy because it’s used if you’ve already had chemotherapy before. Docetaxel and cabazitaxel both contain alcohol. Tell your doctor if having alcohol is a problem for you, for example alcoholism. Chemotherapy may also affect your ability to drive or use machinery. You may want to discuss how to travel to and from your treatment with your nurse or doctor.

Treatments to help manage side effects

As well as the chemotherapy drug itself, you might need to take steroids, anti-sickness drugs (anti-emetics), antibiotics and a drug called GCSF. These can help to manage some of the side effects of chemotherapy.

Steroids

If you’re having docetaxel, you may also be given steroid tablets, such as prednisolone and dexamethasone. You might need to start these before your first treatment session and keep taking them throughout treatment. Or you might just take them for a few days around the time of each treatment session. It’s important to take steroids correctly. And don’t suddenly stop taking them, especially if you’ve been taking them for several months, as this could make you ill. Your doctor will give you more information about this. Steroids can help make chemotherapy more effective, and lower the risk of side effects. They may also help improve your appetite and energy levels, and can treat pain. But steroids can cause their own side effects too – read more about the possible side effects of steroids.

Anti-sickness medicines (anti-emetics)

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You may be given anti-sickness medicines through a needle into a vein in your arm, before having your chemotherapy. You will also be offered anti-sickness tablets to take for a few days after each chemotherapy session to help stop you feeling sick (nausea) and being sick (vomiting). If you continue to feel or be sick, you should talk to your doctor or nurse as they can help manage this.

Antibiotics

You might be given a course of antibiotics to help lower your risk of getting an infection while you’re having chemotherapy. If you do have antibiotics, it’s important to follow the instructions from your doctor and take all the tablets at the right times.

GCSF (granulocyte colony stimulating factor)

If your white blood cell count is too low, you may be given an injection of a drug called GCSF to help your body produce more white blood cells. Read about side effects of GCSF.

After each treatment session

Your hospital team will advise you on how to continue with life while having chemotherapy and who it's safe to be around. In general most men continue with life as normal while having chemotherapy. It’s safe to be around other people when you’re having chemotherapy, including children and pregnant women. If you go to the dentist or have any treatment for other health problems, let the dentist or doctor know that you’re having chemotherapy as it can affect other treatments.

Between appointments

If you have any concerns between your appointments, or get any new side effects or symptoms, contact your doctor or nurse. They can often help you find ways to manage them. When you start your treatment, your chemotherapy nurse should give you details of who to contact at the hospital, including during the night and at weekends. Use this contact number, rather than calling your GP. Remember to call if you have any concerns, even if you think they’re not very important.

prostatecanceruk.org - Chemotherapy | Prostate Cancer UK

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