An Introduction to Chemotherapy

Speaking broadly, there are two strategies for using chemotherapy. One newer approach is to use it early when the cancer is weak and the body is strong. With early use,  it is felt that there is a stronger chance to attack both Androgen Independent and Androgen Dependent cells before the tumor burden is large and well established -- without  devastating the health of the patient. This strategy is used commonly in  breast cancer, a field that is generally considered to be far ahead of  prostate cancer treatment due to multi-disciplinary exposure available to newly diagnosed breast cancer patients and not generally available to newly diagnosed prostate cancer men.

For advanced prostate cancer men, it is strongly suggested to involve a knowledgeable medical oncologist or urologic oncologist, who preferably specializes in prostate cancer, at an early point in treatment.

The second approach is to save chemotherapy for the last ditch therapy, as a possible extension of survival. In the case of hrpca, men have usually undergone a  series of therapies, wishfully called curative. These include surgery,  radiation, and hormone blockade. But, the cancer recidivism is a frighteningly large number following these ‘cures’.

The sequence of treatment for men with HRPC (following standard hormone blockade) is commonly AAWR,  DES or LDK/ HDK+HC (the order of these can vary), then some chemotherapy protocol, then a palliative chemotherapy or bone-seeking radioisotope (for pain relief). At any point in this series, external beam radiation may be used (as ‘spot welding')for pain relief, or clinical trials entered.

In the past, two reasons have been given for saving chemotherapy until the last: (1) It is commonly believed to be the harshest in the series in terms of side effects and often reduces the patient’s quality of life, and (2) The use of chemotherapy may prevent an individual from being eligible for a particular clinical  trial. 

The first of these reasons (harshness) is being disproven with the newer chemotherapy regimens and the judicious use of glutamine and other supportive medications, as discussed in the papers. Many patients find that chemotherapy can be tolerated and a good quality of life maintained, and sometimes at a higher level than some follow-on hormonal blockade treatments. 

The secondly cited reason (clinical trials) should probably not be considered if it entails the risk of delaying or avoiding a chemotherapy that has a strong probability of being effective in suppressing the cancer. Do not let your cancer run out of control in hopes that a clinical trial will cure you.  As always, a benefit - risk approach should be taken and the final decision is yours.

Lastly, the US National Institutes of Health has an excellent booklet that is accessible on-line.  The table of contents and link to their website is below.

Chemotherapy and You

A Guide to Self-Help During Cancer Treatment

Information about what to expect during chemotherapy and what patients can do to take care of themselves during and after treatment. NIH Publication #99-1136.

http://www.cancer.gov/cancerinfo/chemotherapy-and-you

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