Hot flashes have not subsided postcancer treatment

Dear Dr. Roach: I’m a 76-year-old man who was treated for prostate cancer starting in summer 2017. Following radiation therapy, I was given Lupron injections every six months for two years. I still experience hot flashes. Will these hot flashes stay with me for the rest of my life? My urologist assured me that the hot flashes would subside approximately a year after the final shot. — D.T.

Dear D.T.: Leuprolide (Lupron) is a medicine that prevents the body from making testosterone. Back in 1941, depleting testosterone was proven to slow prostate cancer growth, but even in the first group of subjects, there were men with severe hot flashes. The sudden drop in testosterone causes “vasomotor instability,” meaning that the blood vessels in the skin dilate, causing an intense heat sensation. The whole body can cool down with this, leading sufferers to feel cold.

I can’t predict how long these symptoms will last, but it does not shock me that they have continued. Given that they seem to be bothersome, you should ask your urologist or oncologist about treatment. Just as with menopausal women who have hot flashes, there are treatments that can reduce, though perhaps not eliminate, the number of hot flashes you get per day.

There are hormonal and nonhormonal treatments. With hormonal therapy (such as a progestin), there is the possibility of stimulating prostate cancer growth, so most experts prefer trying nonhormonal treatments first. Both antidepressants and antiseizure medicines have been found to work, even though hot flashes are not related to depression or seizures.

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