Patients with advanced prostate cancer will eventually become hormone resistant. At one time there was little available to help these patients except palliative care, but the situation has changed and chemotherapy has been a realistic option for some years. The drug Docetaxel (Taxotere) is often used in combination with other drugs such as Prednisone, and is now a standard treatment on the NHS.
There is no ‘right time’ to start chemotherapy. The treatment will affect your quality of life for 6 months. On the other hand, delaying having chemotherapy until you are seriously ill and unfit may mean worse side effects. It is best to be as strong and as fit as you can beforehand.
Docetaxel is administered as a one-hour infusion every three weeks, usually for up to ten infusions, depending on the patient’s tolerance and response. It acts like a poison to prostate cancer cells, causing cell death. Prednisone, sometimes called Prednisolone (a cortico-steroid), is usually administered at the same time with the object of reducing inflammation and pain. A patient’s hormone treatment may be continued in parallel. In trials, 50% of patients achieved a 50% reduction in PSA level on average, though many men achieve much lower PSAs. As prostate cancer seems to present itself in a variety of forms, every patient’s experience will be different. When Docetaxel is successful, patients can expect their lower PSA to remain for a significant period of time.
Because Docetaxel is toxic, and not specifically targeted at prostate cancer cells, it can and does damage normal cells as well. The number of side effects listed is quite large, common ones being hair loss, damage to finger and toenails, and bone marrow. Patients’ experiences vary. A lucky few are fairly free of side effects; in others, they can be quite severe. Aches and pains, extreme fatigue, particularly in the first week after the infusion, are quite common. Because of the damage to bone marrow, red blood cells can be depleted, leading to anaemia, and white blood cells are reduced, which means that the immune system is compromised. Any infections during the 30-week chemotherapy cycle have to be dealt with immediately, and may even interrupt the treatment cycle.
For bone pain a radioisotope called Strontium 89 may be used. Given as an intravenous infusion, it is taken up by the affected bones. Most men feel the benefit within a few weeks, although for some the pain may get slightly worse before it gets better.
When the PSA starts to rise beyond acceptable levels, there are now drugs such as Abiraterone, as well as others which are under trial and showing good results. Although some of these have not as yet been approved by NICE, there may be means by which these are obtainable, such as the Cancer Drugs Fund and the Named Patient Programme.