March 16, 2009 -- Question: Are there any medical approaches that might help me deal with my hot flashes (as a man receiving hormone treatment for prostate cancer)?
Answer: There are some medical approaches that can help with hot flashes in men with prostate cancer. First off, the cause that there are hot flashes in men with prostate cancer is because there's an abrupt cessation of the testosterone that's around. In women, the reason they get hot flashes is an abrupt cessation of the estrogen put out by their ovaries around the time of their life when that happens. So, when the testosterone goes away, that's what causes the hot flashes. Giving testosterone back would help them, but we don't really want to do that, because that's the treatment for the prostate cancer.
There are other hormones that can be given. You can actually give some estrogen or you can give some progesterone, a couple of female hormones. And those actually can decrease hot flashes. There is some concern about giving those to men with prostate cancer, but the progesterone-type therapy -- either as a pill once a day, or as a shot that can be given at one time, and oftentimes less, for months -- that can help hot flashes, sometimes decreasing hot flashes by about 85 percent.
If a person does not want to use hormone therapy, there is some information that non-hormonal agents are available. Gabapentin is drug that is also called Neurontin. It's been used for people with herpes zoster-type pain and other pain syndromes mostly, and early information suggests that can decrease hot flashes by about 50 percent in studies where it's given. A placebo pill decreases them by about 25 percent, so the difference is about a 25 percent benefit.
There's information in women in randomized placebo-controlled trials that newer antidepressants such as venlafaxine or paroxetine -- Effexor and Paxil being the brand names of those drugs -- do decrease hot flashes by about 50 percent also. Pilot, or early, information in men suggests that they also are helpful in men. The randomized trials haven't been done in men, but they probably do work.