Starting chemotherapy is not the end of the world. In fact, many men who are suffering from symptoms from their cancer will experience a rebound back into the world after starting chemotherapy as these symptoms diminish. For example, pain is often reduced in men starting docetaxel, and quality of life is generally better for men with cancer-related symptoms who receive chemotherapy as compared to no therapy. Currently, the standard of care for men with metastatic prostate cancer that has spread and is progressing despite low levels of testosterone is every 3 week docetaxel, given with prednisone. If cancer has spread to the bones, giving zoledronic acid with docetaxel is recommended. The decision on when to start chemotherapy is difficult and highly individualized based on several factors:
- What other treatment options or clinical trials are available.
- How well chemotherapy is likely to be tolerated.
- What prior therapies you have received.
- If radiation is needed prior to chemotherapy to relieve pain quickly.
Often chemotherapy is given before pain starts, with the goal of preventing this pain from cancer spreading to bones and other sites. Discuss the use of chemotherapy with your medical oncologist early and often, and keep an open mind. We know that using docetaxel has extended life, reduced pain, and improved quality of life, but it does not cure prostate cancer. For this reason, exploring clinical trials of docetaxel combinations or other promising therapies is a high priority in this setting.
There are many clinical trials ongoing in the US and worldwide, and are further described on the following webpage:
Finally, do not be afraid to talk to you doctor about looking around for other therapies. There are many exciting clinical trials ongoing around the country, involving novel agents that have great promise to help men with prostate cancer and many may be appropriate for your current condition. Take your health care into your own hands, as no one can be as strong an advocate for you as you or your family can.