Chemotherapy is a general class of medications used to treat advanced prostate cancer. Chemotherapy works through non-hormonal mechanisms to prevent cancer cells from dividing and making new cells. Because it also affects normal cells to a lesser degree, patients may experience side effects.
Reactions to drugs can vary widely from patient to patient, so it’s important to pay attention to any side effects that you experience, expected or otherwise.
The chemotherapy drug docetaxel is very well tolerated, and many men are surprised to find that disease-related symptoms (pain, fatigue, loss of energy) are improved after starting this therapy. However, docetaxel does have some side effects to be aware of. For example, between 5% and 10% of men will experience a fever with a low white blood cell count that will require medical attention and can be life threatening. The risk can be reduced through the use of white blood cell growth factors such as pegfilgrastim (Neulasta®); note that the use of this supportive medication is at the discretion of the physician who must weigh the benefits of pegfilgrastim against its side effects. Despite use of pegfilgrastim, there is still a risk of serious infection.
About 50% of men will experience significant fatigue at some point in their therapy, usually for the first week of each cycle. About one-third of men will experience numbness or weakness in their toes or fingers that may interfere with function (neuropathy). This side effect is not always reversible, but in most cases resolves slowly over time. There are no treatments available to prevent neuropathy, but reducing the dose of docetaxel, delaying the next dose, or stopping treatment can slow neuropathy and potentially prevent it from progressing. It is important to talk with your doctor if you are developing neuropathy so that you can make a plan about how to best handle further cycles of docetaxel.
Other common side effects of docetaxel are hair loss, diarrhea, nail changes, appetite loss, shortness of breath, and fluid retention. Less common side effects include low platelets which can result in bleeding, anemia, and reduced heart function. Most of these are mild, reversible, and treatable, and should not be a reason to avoid chemotherapy if you need it.
Side effects of cabazitaxel include reduced blood counts, and thus is almost always given with pegfilgrastim to boost infection-fighting white blood cells. Life-threatening infection due to a depressed immune system is the most serious side effect associated with this medication. A blood transfusion is sometimes necessary to treat anemia to combat the fatigue and shortness of breath related to low blood counts. Other possible side effects include: fatigue, neuropathy, shortness of breath, headache, hair loss, abdominal pain, diarrhea, and low blood pressure.
Based on trial results, the FDA now recommends a lower dose than was initially approved to improve tolerability for most patients; the dose can be increased in certain patients.
Regardless of the type of chemotherapy you are receiving, you will be monitored very closely by doctors, nurses, and pharmacists to make sure that all side effects are being addressed. Many of these side effects, especially fever and inability to keep food/drink down, need to be addressed right away—don’t wait until your next appointment to tell your provider.