For patients with advanced prostate cancer who have lost the opportunity for radical surgery, endocrine therapy, including surgical debulking and pharmacologic debulking, is usually preferred, and can also be supplemented with anti-androgen therapy.
Endocrine therapy is often very effective at first, but unfortunately, it eventually fails over time, with most patients experiencing a reappearance of symptoms after 1 to 2 years, thus transforming into hormone-non-dependent prostate cancer.
For this group of patients, there are limited treatment options, with chemotherapy being one option. However, the various chemotherapy drugs are inherently cytotoxic, killing tumor cells while also harming normal cells, so doctors seek a balance between efficacy and side effects to eliminate as much of the tumor as the patient can tolerate.
There are a variety of chemotherapy drugs used to treat hormone-non-dependent prostate cancer, including estradiol nitrogen mustard, mitoxantrone, paclitaxel, and docetaxel. More serious adverse effects include a drop in neutrophils, which can lead to serious infections, and prompt use of leukocyte-elevating drugs by the doctor depending on the patient’s blood picture.
Other adverse reactions to chemotherapy include nausea, fatigue, and diarrhea, which are usually mild and can be tolerated by most patients.
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