Six Myths About Chemotherapy for Prostate Cancer

According to Dr. William Oh,  Deputy Director of  the Tisch Cancer Institute, Chief of the Division of Hematology and Medical Oncology, and Professor of Medicine at the Icahn School of Medicine at Mount Sinai in New York, there are six myths about chemotherapy.

Some prostate cancer patients shy away from or choose not to utilize chemotherapy. Their hesitation may result from an outdated understanding of chemotherapy’s side effects and its effectiveness against prostate cancer. In this blog, Dr. Oh explores the myths driven by common misperceptions about chemotherapy and replaces them with some facts.

MYTH #1:  Chemotherapy is a last resort.

“Some patients believe that we use chemotherapy when we are out of options. Far from a last resort, there are currently promising studies utilizing chemotherapy earlier in the treatment of prostate cancer. For instance, in men with newly diagnosed metastatic disease, chemotherapy significantly improves survival.”

MYTH #2:  Chemotherapy is a single and outdated option.

“Chemotherapy is not a single drug. In fact there are many “chemotherapies”, both oral and intravenous, and new chemotherapies are being developed and approved regularly.

In prostate cancer, there have been continuous improvements over the past few years. In the past, an older drug called mitoxantrone was approved by the FDA to relieve cancer symptoms only. Then something important happened in 2004: docetaxel (taxotere) chemotherapy was shown to be the first drug to improve overall survival for men with metastatic prostate cancer that became resistant to hormone treatments. This was a critical milestone, as no drugs to that point could lengthen survival. In 2010, the FDA approved another chemotherapy drug for prostate cancer called cabazitaxel.

Far from being outdated, these advancements allow me as an oncologist to have a larger toolbox to treat cancers which adapt to different types of treatments. For instance, resistance often develops to drugs like abiraterone or enzalutamide, which target the androgen receptor.  Chemotherapy may more effectively kill those resistant cancer cells.

Finally, ongoing research will determine how best to combine chemotherapy with other drugs and radiation as well as use biomarkers to personalize treatment. We thought chemo might go away with newer treatments, but we use it as often as we did before as men are living longer and better lives with advanced prostate cancer.”

MYTH #3:  Chemotherapy has no role in an era of immunotherapy and precision medicine.

“Some people believe chemotherapy is a ‘shotgun’ approach. Patients want more targeted therapy specific to their cancer. The fact is we do have specific chemotherapy to kill prostate cancer cells called taxanes. Taxanes stop cancer cells from dividing and also may interfere with androgen receptor signaling in prostate cells as well.

In fact, when a patient stops responding to drugs such as abiraterone or enzalutamide, a blood test for a biomarker called ARV-7 predicts greater benefit from chemotherapy than to continue the androgen pathway drug. This test is now approved in the U.S.” (See a recent blog on this website describing AR-V7 testing.)

MYTH #4:  I’ll be nauseated and vomiting throughout my chemotherapy.  

“Chemotherapy induced nausea and vomiting (CINV) can be very scary and intimidating and many patients have known or heard about someone who has had it. Two things are really important to understand about CINV.

First, there are many types of chemotherapy and their ability to cause CINV varies widely.  In fact the drugs used in prostate cancer are unlikely to cause this. The American Society of Clinical Oncology (ASCO) Guidelines consider cabazitaxel, for instance, as a ‘low risk’ drug for causing CINV.

Second, modern antiemetics have revolutionized the treatment of CINV. Antiemetics are drugs used to prevent nausea and vomiting and there are a host of agents available to use. Typically I will incorporate one of these on the day of therapy and prescribe something for home, but most patients do not need it.”

MYTH #5:  I won’t be able to function day-to-day while on chemo.

“Some men believe their quality of life will drastically suffer while on chemotherapy. Fortunately, these newer drugs have much fewer side effects. The most common side effect in day-to-day life is fatigue. This is usually mild to moderate and I find that most patients are able to continue many of their regular activities. For instance, they may continue to work, spend time with family, and exercise.”

MYTH #6:  I’ll permanently lose all my hair after chemo.

“It is true that many prostate cancer patients experience temporary hair loss while undergoing chemotherapy. Some patients won’t lose their hair at all. Others will experience thinning hair.

In nearly all patients, the hair loss is reversible once chemotherapy is complete. If you experience hair loss, your hair should grow back several months following your chemotherapy treatment.”

FACT:  Chemotherapy is a key treatment in the fight against advanced prostate cancer.

“Battling prostate cancer may be the hardest fight you’ve encountered. Certainly, the side effects of some of the treatments you’ve received have been difficult. There is no question that chemotherapy comes with its own set of challenges.

However, it is critical to understand how important chemotherapies used to combat prostate cancer can be in extending and even improving your life. Many studies have shown that drugs such as docetaxel, cabazitaxel, and others can play a key role in treating metastatic prostate cancer, cancer that has spread beyond the prostate.

Please ask your oncology team about any specific concerns you may have before starting any treatment regimen. Knowledge is the most effective tool in the battle against prostate cancer.”

See the following link from Zero-the Fight to End Prostate Cancer, published Jan. 10, 2019.

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