Chemotherapy for Prostate Cancer

When most people think about cancer treatment, they usually jump to chemotherapy. Chemotherapy medications can slow or stop cancer growth. But for prostate cancer, healthcare teams only use chemotherapy in certain situations. And they don’t usually recommend it as a treatment by itself. Let’s take a look at chemotherapy’s role in prostate cancer treatment.

Who qualifies for chemotherapy for prostate cancer?

Chemotherapy — or “chemo” as it can be called — isn't a common treatment for prostate cancer. Chemotherapy can be an option for people who have advanced prostate cancer, like those who have:

• Metastatic (Stage 4B) prostate cancer

• Recurrent prostate cancer with metastasis 

You may also be offered chemotherapy to treat prostate cancer if you participate in a clinical trial. 

It can be difficult to know if you should try chemotherapy as part of your advanced prostate cancer treatment. There are several things you and your healthcare team will need to consider before deciding if chemotherapy is right for you. Some of these include:

• Your overall health, which may affect how well you can tolerate chemotherapy

• Treatments you’ve tried before and how you responded to them

• Need for more urgent treatment with radiation to control pain from metastasis

• Other available treatments, including clinical trials

• Your own treatment goals and priorities

Types of chemotherapy for prostate cancer

There are two main types of chemotherapy for prostate cancer: taxane-based chemotherapy and platinum chemotherapy. Both are discussed below. 

Taxane-based chemotherapy

Taxane-based chemotherapy works by targeting proteins so that cancer cells aren’t able to divide. This helps slow cancer growth. Taxane-based chemotherapy includes the medications docetaxel (Taxotere) and Jevtana (cabazitaxel). People usually receive steroids along with taxane-based chemotherapy.

Platinum chemotherapy

Platinum chemotherapy works by attaching to cancer cell DNA so cancer cells can’t use it. Without access to their DNA, cancer cells can’t divide. The FDA hasn’t approved platinum chemotherapy to treat prostate cancer. It’s only used in very specific situations.

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Can chemotherapy for prostate cancer be combined with other treatment options?

Chemotherapy isn’t given by itself to treat prostate cancer. It’s almost always combined with other treatments.

The exact treatment combinations depend on your individual situation. People starting chemotherapy should work with a medical oncologist — a cancer specialist — who has experience in advanced prostate cancer treatment.

What are the side effects of chemotherapy for prostate cancer?

Taxane-based chemotherapy does cause side effects. This is because chemotherapy medications can damage normal cells along with cancer cells. Some common side effects include:

• Fatigue

• Numbness in the fingers and toes (neuropathy)

• Decreased white blood cells and immune response

• Hair loss

• Skin changes

• Diarrhea

• Appetite changes

• Anemia

• Fluid retention in your legs or lungs

• Damage to your fingernails and toenails

• Tearing of your eyes

This list may seem daunting, but there’s good news: Many of these side effects don’t last for a long time. And other therapies can help lessen them.

Another piece of good news is that taxanes can actually improve symptoms of advanced prostate cancer. Many people experience a decrease in pain and fatigue after starting chemotherapy. 

What are the benefits and risks of chemotherapy for prostate cancer?

Like all medical treatments, there are benefits and risks to chemotherapy. 

Risks 

Some of the risks of chemotherapy include unpleasant side effects and an increased risk for infection. Plus, chemotherapy can’t cure advanced prostate cancer.

Benefits

But there are benefits to chemotherapy too. Chemotherapy does help improve prostate cancer symptoms and quality of life. Some people with advanced prostate cancer feel better after starting chemotherapy, even if they experience side effects. They’re able to more fully participate in their daily activities, which improves their mood and sense of well-being. 

Chemotherapy can also stop cancer progression and help people with advanced prostate cancer live longer. Studies show that people with metastatic hormone-sensitive prostate cancer who take docetaxel and androgen deprivation therapy (ADT) live longer. This is especially the case if they have a large amount of cancer cells in their bodies. People with metastatic hormone-resistant prostate cancer who added chemotherapy to their treatment also lived longer and had slower progression of their cancer. 

You’ll need to go over the risks and benefits of chemotherapy with your care team to determine if this option is right for you.

How do people with prostate cancer receive chemotherapy treatment?

Chemotherapy is usually given directly into the bloodstream using an IV (intravenous) line. Some people need a PICC line or a port (a special IV line). You can get chemotherapy either at an office, hospital, or infusion center. You’ll be monitored as the medication goes into the body.

How often do patients receive chemotherapy for prostate cancer?

Chemotherapy is usually given in cycles. That means you’ll get chemotherapy for a certain number of days or weeks and then get a break. The length of your cycles depends on your specific situation. 

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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