UKMi Q&A xx - SPS
How can hot flushes in men being treated for prostate cancer be managed?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
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Date prepared: April 2020
Background
Prostate cancer is the most common cancer in males in the UK, accounting for 26% of all new cancer cases in males (2016) (1). The main risk factors are age (most cases being diagnosed in men over 65 years of age), ethnicity (more common in black African-Caribbean men), and a familial component (2). Prostate cancer is usually slow-growing and asymptomatic at diagnosis; however, the presenting symptoms of advanced disease are usually urinary outflow obstruction, or, pelvic or back pain due to bone metastases. Treatment decisions are guided by baseline prostate specific antigen (PSA) levels, tumour grade (Gleason score), the stage of the tumour, the patient's life expectancy (based on age and comorbid conditions), treatment morbidity, and patient preference.
Treatment options for patients with prostate cancer include active monitoring, radical prostatectomy, external beam radiotherapy, and brachytherapy (2). Hormone therapy (androgen deprivation or anti-androgens) is the primary treatment for metastatic prostate cancer but is also increasingly being used for patients with locally advanced, non-metastatic disease.
Androgen deprivation therapy (ADT) involves the use of a luteinising hormone-releasing hormone (LHRH) agonist (buserelin, goserelin, leuprorelin acetate, or triptorelin), or bilateral orchidectomy, which removes the supply of endogenous hormone (2). ADT may be continued for up to 3 years in patients with high-risk localised prostate cancer.
ADT carries a risk of side-effects, particularly urinary and sexual dysfunction, loss of fertility, radiation-induced enteropathy, and hot flushes (2). Although there is limited evidence, intermittent therapy may be considered for patients who are having long-term ADT, to reduce drug toxicity.
The exact mechanism of hot flushes is not fully understood (3;4). The thermoregulatory centre in the hypothalamus maintains the core body temperature within a normal thermoregulatory zone (5). It is hypothesised that the withdrawal or reduction of the sex hormones not only causes disruption of the thermoregulatory centre in the hypothalamus but also causes noradrenaline fluctuations that induce hot flushes (also called vasomotor symptoms or hot flashes) (4;6).
Up to 75% of men receiving hormone treatments for prostate cancer have hot flushes (7).
Hot flushes are the sensation of sudden waves of intense heat and a feeling that the face and whole body is flushing (8). They are often accompanied by sweating. Hot flushes can last for a few minutes or up to half an hour and can happen either occasionally, or regularly and frequently during the day and night. They can be unpleasant and debilitating. Sufferers can become drenched in sweat and may also experience chills as the sweat dries on the skin surface.
The intensity of the hot flush can be described as (9):
• Mild: generalised warmth or flushing lasting less than 3 minutes
• Moderate: more warmth and/or flushing than a mild flush, lasting ................
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