Chemotherapy for prostate cancer

概述

Chemotherapy for prostate cancer uses strong medicines to destroy cancer cells or slow their growth. These medicines usually are given directly into a vein through a needle.

Chemotherapy typically is used to treat prostate cancer only when it has spread to many places outside the prostate. Chemotherapy may help people with advanced prostate cancer live longer. It also may help ease pain and symptoms of cancer.

Chemotherapy may be used with hormone therapy for prostate cancer. It also may help treat advanced prostate cancer when hormone therapy isn't working. Chemotherapy generally is not used for early-stage prostate cancer.

Types

The most common chemotherapy medicines used for prostate cancer are:

• Docetaxel (Beizray, Docivyx, Taxotere), typically the first line of therapy. In studies, docetaxel has helped people with advanced prostate cancer live the longest when compared with those treated with other medicines.
• Cabazitaxel (Jevtana), typically the second option when docetaxel stops working.

Docetaxel and cabazitaxel belong to a group of chemotherapy drugs called taxanes. Derived from plants, taxanes work by stopping cancer cells from dividing into new cells.

Other chemotherapy medicines that may be used:

• Mitoxantrone is used to ease symptoms and improve quality of life.
• Platinum-based chemotherapy may be used in combination with other chemotherapy drugs when docetaxel isn't working. Examples include carboplatin and cisplatin.

目的

Chemotherapy may be considered for advanced prostate cancer that has spread more widely in the body. For example, the cancer may spread to the liver or the lungs or to multiple bone spots. Adding chemotherapy to hormone therapy for prostate cancer can help prolong life. It also can ease pain and improve quality of life. Chemotherapy may be given in the following situations.

For prostate cancer that has spread but still responds to hormone therapy

Sometimes, chemotherapy, usually docetaxel, may be combined with hormone therapy to treat advanced prostate cancer that is sensitive to androgen hormones and uses the hormones to grow. This type of cancer is called metastatic castration-sensitive prostate cancer (mCSPC).

Hormone therapy for mCSPC usually involves androgen deprivation therapy and certain hormone blockers, such as abiraterone (Yonsa, Zytiga) or darolutamide (Nubeqa). This combination of chemotherapy and hormone therapy may help extend life.

For prostate cancer that has spread but no longer responds to hormone therapy

Most advanced prostate cancers eventually become less responsive to hormone therapy. This means that although hormone therapy keeps testosterone levels low, the cancer continues to grow. This is called metastatic castration-resistant prostate cancer (mCRPC).

Docetaxel is a treatment option for mCRPC. Cabazitaxel is another option if docetaxel stops working.

Chemotherapy for mCRPC is typically used alongside other therapies, including other chemotherapy drugs, hormone therapies, immunotherapies, radiopharmaceuticals and targeted therapies. The choice of therapies depends on your cancer and treatments you've already had. It also depends on your symptoms, your preferences and the potential side effects of the treatments.

For certain aggressive types of prostate cancer

A combination of chemotherapy drugs carboplatin and cabazitaxel along with steroids may be used for small cell prostate cancer. This is a rare type of prostate cancer that is faster growing. Platinum-type chemotherapy drugs may be used for mCRPC in people with specific genetic variations.

For symptom relief

Mitoxantrone is a chemotherapy drug approved for the relief of symptoms associated with metastatic prostate cancer. It can provide symptom relief by killing some of the cancer cells. It may be helpful when docetaxel, cabazitaxel or both are not working. Mitoxantrone does not prolong survival.

风险

Common side effects

Common side effects of prostate cancer chemotherapy drugs include:

• Bone marrow suppression. Side effects of prostate cancer chemotherapy medicines typically include feeling very tired, easy bruising and more-frequent infections. This is because chemotherapy affects rapidly growing stem cells in bone marrow. As a result, there are fewer red and white blood cells and blood platelets.
• Nerve damage. Chemotherapy drugs also can damage the nerves in the fingers and toes, called peripheral neuropathy. This can cause numbness and tingling in the fingers and toes. Peripheral neuropathy is more common with docetaxel than cabazitaxel.
• Allergic reactions. Both docetaxel and cabazitaxel can cause allergic reactions. Occasionally, reactions can be severe. Steroid medicines such as prednisone can help prevent these reactions.
• Fluid buildup. Docetaxel and cabazitaxel can make your body hold onto fluid, especially in the lower legs. Typically, healthcare professionals prescribe a daily steroid medicine to help prevent this side effect.

Other side effects that may occur during chemotherapy treatment

In the process of targeting fast-growing cancer cells, chemotherapy drugs can damage other fast-growing healthy cells, such as those in the hair follicles and digestive tract. Ask your healthcare team about the side effects of the drugs you'll receive. Possible side effects of chemotherapy drugs include:

• Nausea.
• Vomiting.
• Diarrhea.
• Hair loss.
• Nail changes.
• Loss of appetite.
• Fever.
• Mouth sores.
• Pain.
• Constipation.

Many of these side effects can be prevented or treated. Most side effects go away after treatment ends.

Long-lasting and late-developing side effects

Chemotherapy drugs also can cause side effects that don't appear until months or years after treatment. Late side effects vary depending on the chemotherapy drug but can include:

• Damage to lung tissue.
• Heart problems.
• Infertility.
• Kidney problems.
• Permanent nerve damage.
• Risk of a second cancer. Mitoxantrone rarely can lead to leukemia years later.

Ask your healthcare professional if you have a risk of any late side effects. Ask what signs and symptoms you should be aware of that may signal a problem.

如何进行准备

Before you begin chemotherapy, you'll likely meet with your cancer care team to discuss an approach that fits your situation. Your team considers various factors, including:

• Other cancer treatments you had in the past.
• Cancer medicines you're taking.
• Any symptoms you're having.
• Where the cancer has spread.
• How many places in your body have cancer.
• Your overall health.
• Any other serious health conditions you have and their treatments.
• Your personal preferences and other concerns you have about cancer treatment.

How you prepare for chemotherapy depends on which drugs you'll receive and how they'll be administered. Your team will give you specific instructions to prepare for your chemotherapy treatments. You may need to:

• Undergo tests and procedures to make sure your body is ready to receive chemotherapy. Blood tests to check for kidney and liver function and heart tests to check for heart health can help the care team know whether your body is ready for chemotherapy. If there's a concern, your treatment may be delayed or you may have a different chemotherapy drug and dosage that's safer for you.
• See your dentist. Your care team may recommend that a dentist check your teeth for signs of infection. Treating existing infections may reduce the risk of complications during chemotherapy treatment, since some chemotherapy may reduce your body's ability to fight infections.
• Plan ahead for side effects. Ask your care team what side effects to expect during and after chemotherapy and make appropriate arrangements. For instance, if your chemotherapy treatment causes infertility, you may wish to consider options to preserve your sperm for future use.
• Make arrangements for help at home and at work. A full course of chemotherapy for advanced prostate cancer can last up to six months. Most people can work and do their usual activities during chemotherapy. Your healthcare team can give you a general idea how chemotherapy may affect your usual activities. But it's tough to know exactly how you may feel. Ask your team whether most people in your situation need time off work or help around your home after treatment. Ask for the details of your chemotherapy schedule so that you can plan for work, children, pets or other commitments.
• Prepare for your first treatment. Ask your healthcare team how to prepare for chemotherapy. Have a friend or family member drive you to your first treatment. Most people can drive themselves to and from chemotherapy sessions. But the first time, you may find that the medications make you sleepy or cause other side effects that make driving difficult.

可能出现的情况

Your healthcare professional decides how often you'll have chemotherapy treatments. This is based on what drugs you receive, the type of cancer you have and how well your body recovers after each treatment.

Typically, chemotherapy drugs are given in cycles. A cycle is a period of treatment followed by a period of rest and recovery. For prostate cancer, a chemotherapy infusion usually is given once every three weeks. You also may take a steroid, such as prednisone, every day.

Chemotherapy sessions can take place at your healthcare professional's office, an outpatient unit in a hospital or a clinic. A course of chemotherapy may have 6 to 10 cycles.

Before the procedure

Most chemotherapy drugs for prostate cancer are given through an IV line. Before your chemotherapy starts, your healthcare professional may recommend you get a device, such as a catheter, port or pump. The device is surgically placed into a large vein, usually in your chest. Chemotherapy drugs can be given through the device.

This device stays in place for the duration of your chemotherapy treatment. So you don't need to be stuck with a needle every time you come in for treatment. The device also can be used for blood draws and supportive treatments, such as fluids and antibiotics.

Ask your healthcare team about wearing ice packs around your hands and feet during your chemotherapy session. The cold may help protect the nerves in your hands and feet by reducing the flow of chemotherapy to these areas.

During the procedure

Not all chemotherapy sessions are alike, but a typical session may follow this order:

• You have a blood sample drawn for a blood count and other blood tests.
• You have a brief physical exam to check your temperature, pulse and blood pressure.
• You meet with your healthcare team to review your blood test results and assess your overall health.
• You meet with the member of your healthcare team who gives you your chemotherapy.
• You have the IV line inserted.
• You receive supportive medicines to prevent side effects such as nausea, anxiety or inflammation.
• You receive the chemotherapy drugs. This may take up to several hours.

While you receive the chemotherapy, you can do other quiet activities. Many people read, listen to music or a podcast, or watch a movie or show.

Your healthcare team watches you closely during this time. If you have a reaction or other side effects, members of your team can treat you quickly.

After the procedure

Once you've received all the chemotherapy drug, your healthcare team usually:

• Flushes your IV line and disconnects you from the IV.
• Checks in to see how you're feeling. Your team may take your blood pressure and other vital signs.
• Gives you instructions for what to do when you get home.
• Makes sure you have any prescriptions you need.
• Schedules any follow-up appointments.
• Gives you instructions on proper handling of bodily fluids, such as urine, stool, vomit and semen, as these may contain some of the chemotherapy drugs for the next 48 hours. This may simply involve flushing the toilet twice after use.

Some people feel fine after a chemotherapy session and return to their schedules and activities. Others may feel side effects more quickly. You may want to arrange for someone to drive you home afterward, at least for the first few sessions, until you see how you feel. If you notice side effects after your session, tell your healthcare team. They can help you find ways to relieve your symptoms.

After you complete chemotherapy treatment, your healthcare team schedules follow-up visits to monitor your prostate-specific antigen (PSA) levels. PSA is a substance prostate cells make. Having a high level of PSA in your blood can be a sign of prostate cancer. Your team also checks for long-term side effects.

结果

Chemotherapy does not cure advanced prostate cancer. Still, it can:

• Help people live longer.
• Lower PSA levels.
• Slow cancer growth.
• Improve quality of life by easing symptoms such as pain.

Your care team will use blood tests, scans and how you feel to monitor your response to treatment.