Back to Treatment Options

The term "chemotherapy" refers to any type of therapy that uses chemicals to kill or halt the growth of cancer cells. The drugs work in a variety of ways, but are all based on the same simple principle: stop the cells from dividing and you stop the growth and spread of the tumor.

Until recently, chemotherapy was used only to relieve symptoms associated with very advanced or metastatic disease. With the publication of two studies in 2004 showing that the use of docetaxel (Taxotere) can prolong the lives of men with prostate cancer that no longer responds to hormone therapy, more and more doctors are recognizing the potential benefits of chemotherapy for the men they treat with advanced prostate cancer.

Building on these successes, there are now dozens of clinical trials studying various combinations of chemotherapy drugs, some using new mixes of older drugs and some using newer drugs. Some trials are looking to find a chemotherapy regimen that’s more tolerable or more effective than docetaxel in men with metastatic disease, others are looking to find a chemotherapy regimen that can delay the onset of metastases, and still others are seeking to improve upon the results with docetaxel by adding to it other novel agents and testing the combination.

In addition, several agents are approved or widely available for use in prostate cancer, including estramustine and mitoxantrone. Estramustine (Emcyt) is an oral medication with hormonal and chemotherapeutic properties that has anti-cancer activity, and can be safely combined with other chemotherapies. Mitoxantrone (Novatrone) is a chemotherapy agent given intravenously every three weeks and is known to delay and reduce pain from prostate cancer metastasis from earlier studies. It remains an effective weapon against prostate cancer. However, it does have a risk of congestive heart failure which limits its use to generally under 10 cycles, and regular heart monitoring is necessary.

Paramount in all researchers’ minds is a way to maximize benefit while minimizing side effects. Chemotherapy, like all powerful drugs, can take a toll on the body. A review of how to best manage the side effects of chemotherapy can be found in the Side Effects section.

Off-Label Chemotherapy Use

Strictly speaking, few chemotherapy agents have been approved by the FDA for use in prostate cancer. But over the years, doctors have found that some medications that are regularly used in other types of cancers can be used rather effectively in men with prostate cancer.

Off-label use of a drug means that the drug is approved by the FDA for use in one disease but is being used in another. The drug is known to be safe overall, and has been proven effective for the disease in which it’s approved. That doesn’t mean it’s not effective in prostate cancer as well; it just means that the drug hasn’t been rigorously tested in prostate cancer, so there’s no formal "proof" that it’s effective. Nevertheless, off-label use of chemotherapy is common, and its use is often found to be beneficial in men with prostate cancer.

Because very few drugs will score a home run in every person, second-line chemotherapy has a long and valued tradition in the treatment of cancer. In this setting, off-label drugs are common, and are chosen specifically because they work somewhat differently than what was used first, providing another chance to see a benefit. Some chemotherapy medications that are commonly used off-label after docetaxel has stopped working including vinorelbine (navelbine), paclitaxel (Taxol), cyclophosphamide (cytoxan), and etoposide (VP-16). Because each of these agents may only work for a short period of time, we encourage all men to consider clinical trials of newer promising agents when able.

Back to Treatment Options