Is Chemotherapy Used for Prostate Cancer Treatment?

Types of Chemotherapy Used for Prostate Cancer Treatment

Chemotherapy Used for Prostate Cancer TreatmentConventional chemotherapy has been used for prostate cancer treatment for decades.  So far, there is little evidence that chemotherapy used for prostate cancer treatment early in the course of the disease will alter patient outcome. The main use of chemotherapy for prostate cancer is usually in the advanced setting when the cancer does not respond to hormone deprivation anymore.

In recent years more drugs have been introduced that are not traditionally regarded as chemotherapeutic drugs.  They are considered biologic drugs and work by altering testosterone signaling in the prostate cancer cells and are highly effective. Doctors now tend to use chemotherapy drugs later in the disease course given the better tolerability of the newer drugs.

Farshid Dayyani:  In certain circumstances, chemotherapy might be appropriate to treat prostate cancer.

Conventional chemotherapy has been tested for decades in the treatment of early stage and advanced stage prostate cancer.  So far, we don’t have any evidence that using chemotherapy earlier in the disease, meaning before the cancer has spread, will change anything in the patient outcomes meaning they don’t live longer.  Therefore, the majority of the use of conventional chemotherapy in prostate cancer has been in the advanced setting when the cancer does not respond to hormone deprivation anymore. This so called castration resistant state was very difficult to treat until about 2004.

As a matter of fact, the only FDA approved chemotherapeutic drug until then was mitoxantrone which did not prolong the patient’s life, but improved the pain level of the patient and that’s how it was approved.  In 2004, we had two large randomized trials showing us an effect on overall survival with a drug called docetaxel which improved by about three to four months the survival of the patients, so this was our main treatment for patients with advanced prostate cancer over the past decade.  More recently, a second drug cabazitaxel which is related to docetaxel was approved for patients whose cancer does not respond to docetaxel anymore.

Again in this setting, the patients who received cabazitaxel lived longer than those who received placebo.  Now, we have more and more drugs coming in that are not traditionally regarded as chemotherapeutic drugs.  They are more biologic drugs that affect testosterone signaling in the prostate cancer cells and are highly effective, so in 2013 we tended to use chemotherapy drugs later and later in the disease course given the better tolerability of the newer drugs.

Farshid Dayyani
Dr. Dayyani earned his medical degree in Munich, Germany at Ludwig-Maximilians Universitaet before completing his internal medicine internship and residency at Beth Israel Deaconess Medical Center in Boston, Mass.
Farshid Dayyani

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