Chemotherapy for prostate cancer: where it fits and what to expect

Chemotherapy is not usually part of treatment for prostate cancer that is confined to the prostate. Early cancers are normally managed with active monitoring, surgery or radiotherapy, sometimes with hormone treatment. Chemotherapy is mainly used later in the pathway, for cancer that has spread beyond the prostate, most often to the bones. It may be offered in two main situations: alongside hormone treatment when prostate cancer has already spread at the time it is found, particularly when there is a large amount of cancer, or when the cancer keeps growing even though hormone treatment has lowered testosterone. It is given as a drip in day care, usually every few weeks for a limited course.

Hormone treatment is the foundation of care for prostate cancer that has spread, because most prostate cancers depend on testosterone to grow. Lowering testosterone, with injections, tablets or occasionally an operation, often controls the cancer well, sometimes for years, which is why chemotherapy is not the first choice for most men. Over time, however, many prostate cancers learn to grow despite low testosterone. At that stage, chemotherapy, newer hormone tablets, radiotherapy to painful bones or other treatments may be considered. Hormone treatment is usually continued alongside chemotherapy rather than stopped, but that decision belongs to your oncologist. Never stop or change hormone injections or tablets on your own, even if you feel well.

Typical effects of prostate chemotherapy include tiredness, hair loss, a higher risk of infection when white cells are low, numbness or tingling in the fingers and toes, nail and taste changes, swollen ankles, watery eyes, and loose motions. Many men manage these with support from the chemotherapy team, and the plan can be adjusted if effects become difficult. Whether chemotherapy is suitable depends on how far the cancer has spread, earlier treatments, symptoms, fitness and other illnesses such as heart disease or diabetes. This page explains the general picture and cannot say whether chemotherapy is right for you. Your urologist and medical oncologist will discuss the options together, and with you and your family.

Used later in the pathway

Mainly for cancer that has spread beyond the prostate.

Hormone treatment comes first

Most prostate cancers depend on testosterone to grow.

Given as a drip in day care

Usually a limited course with regular reviews.

It cannot tell you whether chemotherapy is right for you. That depends on your cancer, earlier treatment and health.

It also cannot predict how your cancer will respond. Your oncologist can explain what your tests show.

Why hormone treatment usually continues

Even when prostate cancer grows despite hormone treatment, keeping testosterone low is usually still helpful, so hormone injections or tablets are often continued alongside chemotherapy. This is a decision for your oncologist. Stopping hormone treatment without advice can allow the cancer to grow faster, so always ask before making any change.

Newer hormone tablets

Several newer hormone tablets work differently from standard hormone injections. For some men they are offered instead of chemotherapy or at a different point. Choosing between them depends on earlier treatment, other illnesses, possible effects and cost. Your oncologist can explain the options and why a particular order is suggested.

What the PSA test shows

PSA is a blood test that often rises or falls with prostate cancer activity. It is checked regularly during treatment. A single change does not always mean much, and PSA can briefly rise when treatment starts. Your oncologist looks at the trend over time, together with symptoms and scans.

Scans during treatment

Bone scans, CT scans and sometimes PET-CT scans are used to see where the cancer is and how it is changing. They are usually repeated at planned points during chemotherapy. Bring earlier scan films and reports to each appointment, so new images can be compared with older ones properly.

Radiotherapy for painful bones

Radiotherapy can relieve pain from cancer in a bone and may be given before, between or after courses of chemotherapy. It is often a short treatment. Ask whether it could help if a particular area is painful, and how it would fit around your chemotherapy schedule.

Your tissue sample report

The tissue sample taken at diagnosis describes how aggressive the cancer looks under the microscope. Sometimes a new sample is taken later to look for changes or genetic features that open up other treatment options. Keep copies of every pathology report, as future doctors will need them.

Fitness and other illnesses

Many men with prostate cancer are older and live with heart disease, diabetes or high blood pressure. These do not rule chemotherapy out, but they are carefully considered. Your team may adjust the plan, involve other specialists, or suggest a different treatment if chemotherapy is likely to cause more harm than benefit.

Protecting the bones

Long-term hormone treatment and cancer in the bones can both weaken bones. Bone-strengthening medicines, calcium and vitamin D, and a dental check before some bone medicines may be recommended. Always follow your team's advice, and report new bone pain rather than assuming it is simply age.

Steroids alongside chemotherapy

Chemotherapy for prostate cancer is often given with a steroid tablet to reduce side effects and support treatment. Steroids can raise blood sugar, disturb sleep and change mood. Men with diabetes may need closer sugar monitoring. Take steroids exactly as prescribed and ask before changing anything.

Managing tiredness and activity

Gentle daily activity, such as short walks, often helps tiredness more than complete rest. Eating regularly, drinking enough fluid and planning busy tasks for better days also help. Tell your team if tiredness stops you managing daily life, as low red cells or other causes may need checking.

Clinical trials

Research into prostate cancer treatment is very active, and new medicines are being tested all the time. Some men may be eligible for a clinical trial at different points in their care. Ask your oncologist whether any suitable trial is open, and what taking part would involve for you.

Talking with your family

Prostate cancer and its treatment can affect energy, mood, sexual function and confidence. Many men find these hard to discuss. Involving a partner or trusted family member in appointments, and asking about counselling and support groups, can make treatment decisions and daily life a little easier to manage.

What to do next

Ask your oncologist why chemotherapy is being considered now, what the alternatives are, whether hormone treatment will continue, how side effects will be managed, and how progress will be checked with PSA tests and scans.