For those with late stage prostate cancer, we look at the options of chemotherapy and surgical removal of the testicles.

What is late prostate cancer and how is it treated?

The release of testosterone by the testicles is triggered by a hormone released from the pituitary gland. If the release of testosterone is stopped, the growth of prostate cancer may stop for some time.

When cancer spreads to other parts of the body (‘metastasises’), it is called late prostate cancer. To grow, prostate cancer needs the male hormone ‘testosterone’. When the cancer has spread beyond the prostate to nearby glands or bones (‘metastasised’), its growth can be delayed by stopping testosterone from reaching it. Hormone therapy obviously plays a major role in helping prevent the cancer cells from spreading, and this includes anti-androgen therapy, LHRH agonist injections, as well as surgical removal of the testicles (‘orchidectomy’), though this will only be suggested if absolutely necessary.

Orchidectomy and its side effects

Orchidectomy involves removing the testicles by surgery. Because an orchidectomy cannot be reversed, you must consider the following permanent side effects before you give your permission.

  • You will lose your ability to get or maintain an erection (impotence).
  • You will lose your sex drive.
  • You will be infertile.
  • You will experience hot flushes (this is due to hormonal changes).
  • You will be left with some of the testicle tissue, ‘the shell’ of the testicle. However, it will feel smaller than the real testicle.

What are the risks and side effects of hormone manipulation drug therapy?

The side effects are the same as those of orchidectomy. You will be unable to have an erection, lose your sex drive and be infertile. The testes shrink and many men develop hot flushes, put on weight around the middle and have mild discomfort in their breasts. Some men lose some strength from the bones and muscles and this may need to be checked with special bone scans. Some doctors use intermittent hormone therapy to give a rest from the treatment. During the time you are off treatment you may regain your sex drive and have erections.

As everyone responds differently, it cannot be predicted how long the treatment will be effective. There are other treatments available if you stop responding to the initial hormone therapy. These can include adding another type of hormone to your LHRH agonist treatment such as an anti-androgen (complete androgen blockade). You may be offered treatment with chemotherapy or your doctor may discuss other new drugs that are part of clinical studies.

Chemotherapy

Chemotherapy involves using drugs which can kill or slow the growth of cancer cells by poisoning them. There are many different chemotherapy drugs and some of these have been found to be effective in treating prostate cancer. Chemotherapy is usually given as injections into a vein.

More than one drug may be given. You can usually receive these drugs as an outpatient and you may need to go for treatment every few weeks for several months. The exact timing and length of treatment will depend on the drugs that your doctor feels will be most effective for your prostate cancer.

Chemotherapy slows down the growth of both cancer and normal cells and can cause side effects.

There are new types of Chemotherapy, hormone therapy and other drugs that are being investigated for advanced prostate cancer that are likely to be available in the future. There are also many trials of new drugs and you should speak to your oncologist to see if you would be suitable for one of these trials.

What are the risks and side effects of chemotherapy?

The side effects will depend on the drugs that you receive and will usually stop a few weeks after the course of treatment is completed. Side effects can include feeling sick but you will be given drugs that are very effective at dealing with this problem.

Chemotherapy can sometimes cause damage to the cells in the bone marrow and this can temporarily make you tired and more prone to infections and bruising or bleeding. Your doctor will explain the side effects for your particular chemotherapy regime.

Palliative treatment

‘Palliative’ therapy does not stop the growth of the cancer, but aims to reduce the pain and any other problems caused by it. The following are palliative therapies.

  • Radiotherapy – very effective in reducing prostate cancer pain if the cancer has spread to the bone.
  • Tablets containing steroid drugs – these can be effective but can cause stomach ulcers and fluid retention. Other medication can reduce these side effects.
  • Bis-phosphonates – at this stage of the disease your doctor may recommend medicine that helps prevent thinning of the bones. This is a relatively new treatment.

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