Burning hot flashes continue after stopping Eligard injections

DEAR DR. ROACH ❯❯ I am 63 and was diagnosed with aggressive prostate cancer in 2020. I had my prostate removed. Unfortunately, they found that the cancer had spread to the lymph nodes. I have since had 35 treatments of radiation and also started hormone suppression treatments (Eligard).

In April 2022, after extensive imaging tests, I was told that I was cancerfree, and my PSA was 0.0 ng/ml.

My last injection of Eligard was given at the end of February 2022. I was scheduled to receive the next injection at the end of August 2022, but my urologist said that we will not do the injection anymore, since the PSA was still 0.0 ng/ml and all imaging indicated I was cancer-free.

Unfortunately, I have experienced all of the usual possible side effects from the Eligard injections: weight gain (45 pounds), terrible muscle loss (especially in my legs), horrible hot flashes, lack of energy, etc. And, as is expected, my testosterone levels are almost at 0.

My urologist stated that my body should start to bounce back to normal and start producing testosterone within about six months after stopping the Eligard injections.

I still have a very odd variation of hot flashes; when they come on, I feel a terrible burning sensation under my skin. This starts in the groin, spreading up my torso into both inner forearms and down my legs. When I told both my urologist and oncologist about these, they both stated that they have no idea what may be causing this and have never heard of this type of problem before. They are both assuming that it must be some type of variation of hot flashes. The frequency of these has been increasing lately, not diminishing the way I expected.

So, I just wonder what your thoughts might be. How long should it take for my body to bounce back to “normal” post-Eligard? And do you have any ideas as to what might be the cause of these terrible burning sensations I continue to experience?

DEAR M.M. ❯❯ I agree that these burning sensations are likely to be a kind of vasomotor instability. That's the medical term for the cause of a hot flash. The blood vessels in the skin open up inappropriately and cause the person to get very warm and flushed, often sweating. The person can lose so much heat that they will be cold once the hot flash is over. The term “flash” can be a misnomer — the heat sensation may last anywhere from a few minutes to 20 minutes.

There are effective treatments for hot flashes. Cyproterone is an anti-androgen that is effective for treatment in men with low testosterone levels due to treatment for prostate cancer. Venlafaxine is a non-hormonal treatment, normally used for depression, that is modestly effective at improving symptoms. Megesterol is a progestin-type of drug that is effective but can cause progression of prostate cancer.

I have read experts say that the hot flashes begin to get better as soon as treatment is over, while other experts have noticed that they may last long-term. My experience is that most men start to get relief about a year after stopping the leuprolide (Eligard and others), although it is highly variable. I would definitely ask your doctors about your treatment options, and I suggest trying the leastrisky treatments initially.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.

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