Options for hot flush management in prostate cancer
UK Medicines Information (UKMi) has published a review of the current strategies for managing hot flushes associated with hormone treatment for prostate cancer.
Up to 75% of men receiving hormone treatments for prostate cancer have hot flushes. According to the paper sufferers can become drenched in sweat and may also experience chills as the sweat dries on the skin. The symptoms can be very debilitating.
First-line management should include: wearing layers of light clothing made of natural fibres that can be removed during a hot flush; having lukewarm showers or baths; stress management (since heightened emotions can cause hot flushes); and reducing or removing coffee, tea, alcohol and nicotine intake.
Medications to manage hormone-induced hot flushes should be added only after making lifestyle adjustments. Oral medroxyprogesterone 20mg a day should be first-line therapy as recommended by NICE; however, it should be noted that the drug is not licenced in this indication.
Cyproterone acetate is recommended as second-line treatment where medroxyprogesterone is not tolerated or not effective after a trial for 10 weeks. Cyproterone at 50mg twice a day should show an effect in four weeks. Cyproterone is licenced for the treatment of hot flushes in patients receiving hormone treatment or who have had orchidectomy.
A variety of other drugs are used to manage hot flushes in men on hormone therapy but the evidence for these treatments is scant and often based on their use in women with menopausal flushing, the report says.
There is no good evidence for clonidine but one case report shows positive results. Estradiol in gel and patch form have shown some benefit but studies are limited. Gabapentin has shown efficacy in a phase 3 trial where hot flushes were reduced by around 40%.
Selective serotonin-reuptake inhibitors (SSRIs) and related drugs including fluoxetine, paroxetine, sertraline and venlafaxine have shown some benefit in small studies and some case reports.
According to the report authors, optimum doses of these drugs may be difficult to determine, and so starting with a low dose and titrating upwards until hot flushes are controlled, or until adverse events lead to discontinuation is recommended.