Eventually, hormone therapy will no longer be effective, and the cancer will continue to grow. When this happens, the LHRH agonists or antiandrogens have stopped working and the cancer is said to be “hormone refractory” or “castration resistant.” This type of cancer is hard to treat chemotherapy is an option. Chemotherapy is the use of a cancer-killing drug or a combination of drugs to shrink the cancer and limit the survival of cancer cells. These drugs kill rapidly growing cancer cells but may also harm other cells in the body that also divide rapidly.

Chemotherapy is given in cycles of treatment followed by a recovery period (no chemotherapy). It is usually given intravenously (into a vein) but some drugs can be taken by mouth. Intravenous chemotherapy may be given at a clinic, your doctor’s office, at home, or in the hospital.

Three chemotherapy drugs are primarily used to treat advanced prostate cancer: docetaxel (Taxotere), mitoxantrone (Novantrone), and cabazitaxel (Jevtana). Docetaxel combined with a steroid, such as prednisone, is the standard drug combination when chemotherapy is used for castration-resistant prostate cancer. The combination is used to reduce cancer pain and to improve survival by an average of several months. It is given every 3 weeks. The length of treatment is based on how effective it is in killing cancer cells and how well the side effects are managed. Alternative treatment regimens include docetaxel plus mitoxantrone or mitoxantrone with prednisone.

Side Effects

Although chemotherapy may reduce the pain of metastatic cancer and prolong life, it also causes significant side effects that affect the quality of life. Among the noncancerous cells that chemotherapy can harm are the cells of hair roots (follicles), the lining of the digestive tract and mouth (mucosa), and blood cells (Table 2). The specific side effects depend on the amount and type of treatment given and for how long.

Other side effects that are less common may include shortness of breath, skin rash, tingling or numbness in hands and feet, and watery eyes. Your doctor can suggest medicines that can help prevent many side effects or make them milder. Most side effects go away when treatment ends.

Monitoring Response

Monitoring your PSA level is one way to see how well the chemotherapy is working, and other blood tests, an examination by your doctor, and x-rays contribute to an evaluation of the results of treatment.

Table 2. Some Common Side Effects of Chemotherapy

Site Affected	Side Effect
Hair follicles	Hair loss may begin 2-3 weeks after the start of chemotherapy.
Lining of mouth	You may experience a dry mouth, sores or white patches on your lips or in your mouth, pain when eating hot or cold foods, and changes in taste or smell.
Lining of digestive tract	You may feel sick to your stomach (nausea), have vomiting, diarrhea, and loss of appetite.
Bone marrow (where blood cells are produced)* decrease in the number of white blood cells (infection-fighting factors) decrease in the number of platelets (blood cells that cause blood to clot in order to stop bleeding) decrease in the number of red blood cells (anemia)	A low white blood cell count increases the risk of infection. Signs of infection include fever, chills, cough, sore throat, earache, burning or pain with urination, cloudy urine, skin rash, mouth sores, pain or swelling on body. Bruising or bleeding may occur from minor injuries. Signs may include headaches and changes in vision in addition to bruising and bleeding. You may feel very tired or weak (fatigue).
Fluid retention	Signs may include swelling of your hands, feet, arms, or face and bloating or swelling of your stomach area.

*Blood tests will identify low blood counts.

Questions about Chemotherapy You May Want to Ask Your Doctor

What are the benefits of chemotherapy for me?
How does chemotherapy work?
Which drug or drugs will I receive? When will the treatment start and how long will it take?
What side effects can I expect and how can they be treated?
How long will the side effects last?
How will my daily activities be affected?

Additional Sources of Information

National Cancer Institute: www.cancer.gov
Chemotherapy Side Effects Fact Sheets
National Comprehensive Cancer Network: www.nccn.com
Guide to Chemotherapy