Chemotherapy is typically a systemic treatment. This means that the drugs travel through the bloodstream to reach and destroy cancer cells throughout the body, including those that may have detached from the primary tumor in the prostate.

Because chemotherapy generally targets rapidly growing cancer cells, it is not recommended for men with early-stage prostate cancer that is growing slowly.

In the case of prostate cancer, chemotherapy is most often used to treat men whose cancer has recurred or spread to another part of the body after hormone therapy.

It plays an important role in treating prostate cancer that has become resistant to hormone therapy (hormone-resistant, castration-resistant, or refractory).

Research protocols are underway to assess the potential of combining chemotherapy with prostatectomy or radiotherapy in patients with more aggressive cancer.

Finding a clinical trial can be a difficult and complex process. That’s why our partner Q-CROC has established Onco+, a free support service offered to anyone looking for a clinical trial in oncology in Quebec.

If you would like to learn more about clinical trials in oncology in Quebec and assess whether participation in a clinical trial could be an option for you, please visit our partner Q-CROC’s website.

Other sites on clinical trials:

• Clinical Trials Gov: www.clinicaltrials.gov
• Canadian Cancer Trials: canadiancancertrials.ca

Factors justifying this choice

In men with prostate cancer, chemotherapy can help:

• slow the spread of cancer;
• prolong life;
• relieve pain or manage symptoms that may occur at more advanced stages.

The most commonly used chemotherapeutic agents in the treatment of metastatic prostate cancer are:

• docetaxel (Taxotere)
• cabazitaxel (Jevtana)

Docetaxel (used in combination with prednisone or prednisolone) has shown a survival benefit in the treatment of cancer resistant to hormonal therapy.

Cabazitaxel is a chemotherapy drug used with prednisone to treat patients with prostate cancer that has spread outside the prostate and who have already been treated with docetaxel.

Both docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemotherapy drugs. They can slow the growth of cancer and also alleviate symptoms, resulting in a better quality of life.

Castration-resistant prostate cancer

Without metastases

Hormone therapy-resistant prostate cancer without detectable metastases is currently an area of research in the field of prostate cancer. In recent years, some new-generation anti-hormonal drugs in tablet form – apalutamide (Erleada), enzalutamide (Xtandi), or darolutamide (Nubeqa) – have been shown to be effective in patients with castration-resistant prostate cancer without metastases with a rapid rise in PSA. Your doctor may suggest one of these options if your cancer is at high risk of progression.

You may also consider participating in a research protocol to benefit from new forms of therapies.

With metastases

Metastatic castration-resistant prostate cancer occurs when cancer has spread to parts of the body other than the prostate and is capable of growing and spreading even if medications or other treatments aimed at reducing male hormones (testosterone) are used to treat it.

This is the stage of cancer where diagnostic tests such as bone scans or CT scans have detected metastases. At this stage of cancer, unfortunately, we can no longer talk about a cure, and prolonging the patient’s life and quality of life become the priority.

The doctor tries to delay the complications – general impairment, weight loss, pain, and fractures – due to the progression of metastases as much as possible. Indeed, from the moment the cancer becomes resistant to castration and has detectable metastases, symptom relief through hormone therapy is still necessary, but no longer sufficient. Chemotherapy improves the overall condition of the patient who is starting to be very affected by the disease.

In addition, while older hormonal treatments are still useful and should continue to be used, adding a new generation of hormonal agents, such as apalutamide (Erleada), enzalutamide (Xtandi), and abiraterone acetate (Zytiga), offers substantial benefits to patients.

In addition to your treatments, relieving symptoms and side effects is an important part of caring for and treating metastatic cancer. Painkillers are prescribed to relieve pain, both bone and others, treatments to strengthen bones, for example, zoledronic acid (Zometa) or denosumab (Xgeva), and even palliative radiotherapy. Dietary supplements (such as Ensure) and blood transfusions in case of anemia are also helpful.

You may also consider participating in a research protocol to benefit from new forms of therapies.

Although these treatments may help relieve your symptoms, they do not lead to a cure. However, since they act on your entire body, they can help slow down the growth of your cancer, regardless of which parts of the body the cancer cells have spread to.

Advantages of chemotherapy

• It can slow down the spread of your cancer.
• It can treat prostate cancer, no matter where it is in your body.
• It can be used with other treatments.
• It can alleviate your pain associated with advanced stages of cancer.
• It can prolong your life.

Disadvantages of chemotherapy

• It can cause side effects that could have a significant impact on your daily life.
• Some side effects persist as long as chemotherapy is not discontinued.

Risks and complications of chemotherapy

The specific side effects depend on the type of drugs administered. The following side effects are common with most types of chemotherapy:

• Gastrointestinal problems such as nausea, vomiting, and diarrhea
• Fatigue and anemia
• Total or partial hair loss
• Skin sensitivity
• Vulnerability to infections (most commonly chest, mouth, throat, and urinary tract infections)
• Nail changes
• Infertility

Questions for the medical team

To get answers to your questions, you need to prepare. Before meeting with your doctor or nurse, make a list of questions to ask. Making a list of questions before your appointment with your doctor can be a way to put on paper what concerns you.

• Write down the most important questions on your list first.
• Bring a loved one with you.
• Remember that this meeting is not your only chance to ask questions.
• Try to accept that uncertainty exists; medicine does not have a definitive answer to all questions.

We invite you to visit our page Questions to ask your doctor and healthcare team about advanced prostate cancer. Asking questions will open communication, provide information tailored to your situation, and reduce the stress associated with understanding your treatments.