March 16, 2009 -- Question: What is chemotherapy, how is it administered for prostate cancer, and what are the risks/side effects? (Hair loss, bleeding, nausea, etc.)
Answer: Chemotherapy refers to a group of chemical compounds or drugs that are specifically directed toward killing the cancer cells. They do it through a wide variety of different mechanisms, but the major goal is to target the DNA -- or the ability of the cell to reproduce -- and what we want to do is kill the cell by preventing it from dividing. Chemotherapy can be given many ways; it can be given as a standard as an intravenous -- or by vein -- or by mouth.
The side effect profile, depending on the chemotherapy, of course, will differ, but in prostate cancer, many of the chemotherapy drugs that we use are extremely tolerable. Our goal is to keep patients at work or traveling or do whatever they can to maintain their activities of daily living. The traditional side effects have always been the possible lowering or reduction of the white blood cell count and, occasionally, the cells that are responsible for blood clotting, which are the platelets. But in general, it's very, very well-tolerated.
In the old days, when we talked about chemotherapy, we referred to chemo as the "C word," meaning that it was associated with a problem of nausea, vomiting, hair loss. While it's true that many of the chemotherapies that we have now for prostate cancer will result in a slight loss of hair, many of those treatments do not result in baldness. Similarly, for the old side effects of nausea, vomiting, we have some marvelous drugs that are given at the time of chemotherapy and after that patients can use that really prevent them from becoming nauseated or unable to perform their work. Most of the time, people are able to go to work.
Chemotherapy's given as an outpatient, meaning that they should just come in get their chemo and then be able to go to work the next day or the same day. Other side effects might include some fatigue that may not be immediate but may occur two to three days after, and a patient may find that he or she may need to just relax a little bit more on that day. But in general, it's well-tolerated and most people are really very surprised that they feel as good as they do after it's administered.