The characteristics of different tumors vary, and their sensitivity to chemotherapy varies widely. Unlike chemotherapy-sensitive tumors such as lymphoma and choriocapillary epithelial carcinoma, prostate cancer is recognized as a chemotherapy-insensitive tumor. However, with the introduction of new drugs, chemotherapy is becoming increasingly important in the treatment of prostate cancer.
Despite the widespread availability of prostate specific antigen (PSA) testing, there are still many patients with advanced disease at the time of detection, such as progressive prostate cancer, metastasis or recurrence of prostate cancer, for whom endocrine therapy is the first line of treatment.
Early endocrine therapy is usually surgical (orchiectomy) and pharmacologic, but after 18-24 months of treatment, patients become less androgen-dependent and resistant to endocrine therapy, thus progressing to castration-resistant prostate cancer (CRPC).
In the past, patients with CRPC could only receive palliative care, and while switching to other endocrine therapy helped reduce symptoms, it did not prolong survival.
It was not until 2004, when docetaxel was approved as the standard of care for metastatic debulking-resistant prostate cancer, that chemotherapy drugs were effectively used in the treatment of CRPC. The majority of prostate cancer deaths were in patients with CRPC, most of whom had hope of receiving chemotherapy before death.
What are the commonly used chemotherapeutic agents?
To date, an increasing number of commonly used prostate cancer chemotherapy drugs are available in the clinic: docetaxel, cabazitaxel, mitoxantrone, and estradiol phosphate nitrogen mustard.
- Docetaxel: first-line chemotherapy for metastatic hormone-sensitive prostate cancer chemotherapy and metastatic debulking-resistant prostate cancer, which can prolong patient survival with relatively few toxic side effects;
- Carbataxel: second-line chemotherapy for metastatic desmoresistant prostate cancer, which can prolong patients’ survival, but is currently not available in China;
- Mitoxantrone: Used in first- or second-line chemotherapy for metastatic desmoid-resistant prostate cancer, it can improve symptoms and PSA levels, but does not prolong patient survival; therefore, it is rarely used in first-line chemotherapy for metastatic desmoid-resistant prostate cancer;
- Estradiol phosphate mustard: It has both chemotherapeutic and endocrine effects and can improve symptoms and lower PSA in patients with metastatic desmoid-resistant prostate cancer, but does not prolong survival; it has the advantage of being administered orally and can be used as a treatment option in China for patients who are resistant to docetaxel therapy or who cannot choose docetaxel therapy;
- Platinums are also used in some cases for chemotherapy for prostate cancer.
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Among them, docetaxel, the most commonly used domestically, is derived from paclitaxel, which comes from the bark of the Pacific yew tree, which stabilizes microtubules within cells and prevents their depolymerization.
Studies have shown that docetaxel can prolong survival in hormone-refractory prostate cancer and provide pain relief and improved quality of life, so chemotherapy may be considered for clinically hormone-refractory prostate cancer.
Of course, there are side effects to this chemotherapy, such as the most dangerous anaphylaxis that can lead to death, and other adverse effects including bone marrow suppression, malaise, edema, neurotoxic effects, and more.
Patients receiving prostate chemotherapy therefore need to sign an informed consent form and be in good general health to tolerate a full cycle of chemotherapy (about 10 sessions every 3 weeks).
Which patients need chemotherapy?
Patients who need chemotherapy
In general, there are two major categories of prostate cancer that require chemotherapy:
- Metastatic hormone-sensitive prostate cancer: only 6 weeks of chemotherapy with docetaxel in combination with or without prednisone improves median survival by 13 to 20 months (depending on the study) and is therefore recommended for patients with prostate cancer;
- Metastatic desmoplastic-resistant prostate cancer: With docetaxel in combination with prednisone regimens, effective patients require 10 weeks of chemotherapy, which also prolongs patient survival but for a relatively short period of time, and the combined benefit is not as good as prostate cancer at the hormone-sensitive stage.
Also, focus on the following conditions:
- The patient’s physical status to tolerate chemotherapy;
- The patient’s bone marrow function, liver and kidney function can tolerate;
- Patients undergoing chemotherapy in the metastatic hormone-sensitive phase should generally be no older than 75 years.
In conclusion, chemotherapy can prolong survival, control pain, reduce malaise, and improve quality of life in patients with CRPC, and is now considered an important treatment for CRPC.
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