Relief from hot flashes takes time

Dear Dr. Roach: Iam 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 cancer-free, and my PSA was 0.0 ng/ml.

My last injection of Eligard was given at the end of February 2022. 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, 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. The frequency of these has been increasing lately, not diminishing. So, I just wonder what your thoughts might be.

Answer: 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. 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 that is modestly effective at improving symptoms.

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 ask your doctors about your treatment options.