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  1. There are five Thursdays in this month. Each Thursday I aim to present one of the YouTube videos from the PCRI. Hormone therapy, also called androgen deprivation therapy (ADT) keeps most of us alive by robbing the body (and the prostate cancer) of androgens. The main androgen is testosterone. When our bodies are without testosterone, some men experience hot flashes (also called hot flushes). The experience varies from man to man. Some men have no hot flashes. Others have their life very affected. Personally, my hot flashes were mild at first, and gradually faded to undetectable over a few years. In this video, PCRI’s Executive Director, Mark Scholz, MD, discusses various methods for managing hot flashes that occur in men who are undergoing hormone therapy for prostate cancer: And a reminder that we have a few videos of our own on the JimJimJimJim channel: https://www.youtube.com/jimjimjimjim/videos The Prostate Cancer Research Institute (PCRI) is an important source of information for about prostate cancer for patients, families, and the medical community. As part of their mission to empower men and their caregivers they make YouTube videos.
  2. alanbarlee

    Hot flushes from ADT

    Margaret asked about hot flushes at our September 2019 call-in conference. Here's some up-to-date information from one our leading urologists. Hot flushes (extracts from ACCP Consensus Conference 2019 - UroToday) The important topic of hot flushes caused by androgen deprivation therapy (ADT) was discussed by Dr. Frydenberg (Melbourne urologist). Hot flushes are defined as a subjective feeling of warmth in the upper torso, followed by excessive perspiration. Approximately 80-90% of men on ADT endure hot flushes, with 27% reporting them as the most troublesome side effect. Hot flushes have been associated with patient embarrassment, helplessness, and distress during treatment. They can last for the entire duration of treatment and significantly affect quality of life and sleep. The reduction of plasma sex hormones levels from previous normal levels alters the function of brain neurotransmitters such as noradrenaline, serotonin, GABA, dopamine, and beta-endorphins. The thermoregulatory centre in the hypothalamus is anatomically close to the LHRH secreting neurons, and by proximity, the thermoregulatory centre can be reset. There is a positive correlation between hot flushes and LH surges. Hot flushes have been reported to worsen with longer ADT treatment durations and are also worse in younger men with lower BMI.3 Some complementary treatments that can be used include: Exercise – especially high-intensity aerobics and resistance training Cognitive-behavioural therapy Diet – no benefit has been shown in randomized controlled trials for phytoestrogens Acupuncture – reports of 70-80% reduction in flushes with either dry needling or electro stimulated needling. Moreover, patients maintained less than 50% reduction in their hot flushes 9 months after cessation of treatment in 46% of patients. Hot flushes are a common and troublesome side effect of ADT. It is imperative that patients avoid known triggers of hot flushes and promote conservative therapies. An intermittent androgen blockade is a good option where appropriate and safe. It is reasonable to consider progesterone and SSRI/SNRI (anti-depressants) as first-line medical therapy. Lastly, complementary therapies are always recommended (acupuncture and exercise).
  3. As mentioned in another thread I started Lucrin Depot quarterly injections in March 2017. I had my most recent one last Monday. Previous thread I've had hot flushes the whole time since 2017 except for a few months when I was taking Androcur (stopped taking it in April this year). I've noticed over the last few months that the flushes have become noticeably longer-lasting and 'wetter' but, perhaps, not as frequent (still have at least 6 or so every 24 hour more often in bed). Also on occasion a flush was definitely brought on by an anxious or stressful thought. For example, about 2am this morning in bed, I was thinking about some gardening my wife and I had done the previous afternoon. There's a slight slope in the garden and I had a sudden picture of my wife falling down. This instantly started a vigorous flush. The flushes are not always associated with anxiety but I was just wondering if a discussion of a correlation between flushes, ADT and anxiety has ever come up?
  4. In today's teleconference it was suggested that Megace might be useful to reduce hot flushes. I notice that Chuck Maack recently referred in a US forum to a warning by top Medical Oncologist Stephen Strum against men on androgen deprivation therapy using Megace for hot flushes. Strum warns: "I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone. When the PSA is in good control and the testosterone is low, I use Depo Provera intramuscular injection 400mg ONCE and that usually eliminates hot flashes forever. The emphasis on "usually" added since there are rare cases wherein the hot flashes are not reduced/eliminated. Therefore, a 400mg Depo Provera intramuscular injection just once would be what I would have done were I experiencing hot flashes. Make sure the prescribing/administering physician is providing Depo Provera and at the recommended dose, and not Provera. Though both are Medroxyprogesterone, the difference is that Depo Provera is an addition of acetate. There are physicians not familiar with that difference who prescribe Provera when the requirement is, specifically, Depo Provera. HOWEVER, IMPORTANT TO NOTE: Depo Provera has also been known to cause gastrointestinal bleeding and a low HCT percentage can also be attributed to loss of blood. If you are experiencing fatigue and shortness of breath subsequent to Depo Provera, you may be experiencing a blood loss with this gastrointestinal bleeding and don't know it. Be sure your physician keeps an eye on red blood counts (RBC) as well as HGB and HCT levels". You should not start any treatment for hot flushes unless you have first discussed it with your doctor.
  5. Gabapentin Helps Hot Flashes From Prostate Cancer Treatment Key Words Prostate cancer, hot flashes, hormone therapy, gabapentin (Neurontin®), supportive care. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.) Summary The drug gabapentin (Neurontin®) effectively reduced the intensity and duration of hot flashes in a clinical trial of more than 200 men receiving hormonal treatment for their prostate cancer. Source American Society of Clinical Oncology (ASCO) annual meeting, Chicago, June 3, 2007 (see the meeting abstract). The results were published online Jan. 6, 2009, in the Annals of Oncology; see the journal abstract. Background Hot flashes - sudden increases in body temperature that can cause discomfort, sweating, and flushing of the skin - occur when changes in hormone levels interfere with the body’s ability to regulate its temperature. Hot flashes are a common side effect of hormonal therapies for breast and prostate cancer. An estimated 60 to 80 percent of men receiving hormonal therapy for prostate cancer experience hot flashes, which may continue for as long as eight years. The anticonvulsant drug gabapentin has shown some effectiveness as a treatment for hot flashes in women with breast cancer. Anecdotal evidence has suggested it might also relieve hot flashes in men receiving hormonal therapy for their prostate cancer. The Study This study, which began in December 2001, involved 223 men who were receiving hormonal therapy for prostate cancer and were experiencing at least 14 bothersome hot flashes a week (see the protocol summary). The patients were assigned at random to one of four treatment groups. In three of the groups, the men took gabapentin at doses of 300 mg, 600 mg, or 900 mg a day for four weeks. Men in the fourth group received a placebo. Before starting to take the study medication, the men kept track for one week of how many hot flashes they had and how severe they were. This provided a baseline measure of the frequency and severity of their hot flashes. While taking the study medication, they recorded the frequency and severity of hot flashes in daily diaries. Researchers led by Charles L. Loprinzi, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn., measured the average difference between the number and severity of hot flashes patients reported having at baseline and after four weeks of treatment. This study was conducted by the North Central Cancer Treatment Group, one of 12 cooperative groups sponsored by the National Cancer Institute to conduct large-scale cancer clinical trials. Results After four weeks of treatment, the frequency of hot flashes had diminished by a median of 46 percent in the men taking 900 mg a day of gabapentin. This compared with 22 percent in the men taking a placebo, 23 percent in those taking 300 mg of gabapentin, and 32 percent in those taking 600 mg of gabapentin. Ratings of distress from hot flashes declined by about 20 points in the groups taking 600 mg or 900 mg a day of gabapentin, compared with five points in the groups taking a placebo or 300 mg a day of gabapentin. Comments “The study team has a high degree of confidence that gabapentin at a dose of 900 mg a day moderately decreases hot flashes related to” hormonal therapy in men with prostate cancer, Loprinzi concluded in his presentation of the study findings at the ASCO meeting. This is the only placebo-controlled study to show that a nonhormonal therapy can relieve hot flashes in men, Loprinzi added. Although gabapentin is not approved by the U.S. Food and Drug Administration for the treatment of hot flashes, Loprinzi said that on the basis of this study’s results it is reasonable for doctors to try this treatment option in men who are bothered by hot flashes resulting from prostate cancer treatment. From the Web site of the National Cancer Institute (http://www.cancer.gov)
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