Treating Hot Flashes Caused by Hormone Therapy

PCRI’s Executive Director, Mark Scholz, MD, discusses various methods for managing hot flashes that occur in men who are undergoing hormone therapy for prostate cancer.

0:07 Hot flashes are one of the most common side effects of androgen deprivation (also known as testosterone inactivating pharmaceuticals, hormone blockade, etc.) Around one-third of men on hormone therapy experience intense hot flashes; another third of men experience mild hot flashes, and the last third of men don't experience them at all. Hot flashes can be persistent, disruptive, and they may sometimes cause an ominous feeling that something is wrong; however, they are not actually dangerous. Treating hot flashes means treating their symptoms. There are no perfect remedies for hot flashes, but there are a few options, and deciding on the right treatment means balancing the side effects of the treatment with the hot flash symptoms.

1:15 The use of estrogen can dramatically reduce the symptoms of hot flashes in about 80% of men. Estrogen pills predispose men to blood clots, and so transdermal patches are used instead. Vivelle Dot is the most common brand. Breast growth is a risk and radiation treatment to the nipples is an option for preventing breast growth

2:28 Low doses of Effexor, a medicine traditionally used to treat depression, or Neurontin, a medicine traditionally used to treat seizures, are both options for treating hot flashes, although they are only effective in about 50% of men. Drowsiness is a common side effect, and so it is best to take them before sleep.

3:14 There are studies that have demonstrated that acupuncture is effective for treating hot flashes, although it is not something that will work for everyone. It is important to ensure that that acupuncturist you use is truly an expert.

3:40 Progesterone has been used historically to treat hot flashes; however, recent studies suggest that it enhancing prostate cancer growth, so at this time the use of progesterone to treat hot flashes during hormone therapy is not recommended.

4:07 Switching from Lupron (or an analog) to Casodex is another option for alleviating the symptoms of hot flashes since Casodex has a lower incidence of hot flashes. It depends heavily on the situation though because Casodex does not have the same anti-cancer efficacy as Lupron.

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