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Advanced Prostate Cancer
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HOT FLASHES – Why? What to do?

We often hear prostate cancer patients recommending to other prostate cancer patients regarding hot flashes: get “MEGACE!” – NOT for prostate cancer patients, my friends!

Medical Oncologist Stephen B. Strum, M.D., FACP – renowned for his experience and expertise in the treatment of recurring and advanced prostate cancer:

“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 GI 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. With the administration of Depo Provera patients should follow-on having their Prolactin level checked to see if elevated (if earlier controlled), or in any event, to make sure that level is kept below 5ng/ml as explained in this paper tinyurl.com/7w5omeo. The introducing of any new medications can temporarily cause a Prolactin rise, but once the medication is stopped, within a few days that elevation should return to normal.

Adding to NOT prescribing Megace is this commentary by Dr. A. Oliver Sartor: “"Megace® is used at times for patients who have hot flashes, and at times for patients to boost their appetite. But in prostate cancer, Megace may interact with the androgen receptor, particularly mutants, and cause excessive cancer growth. And you can actually get responses by withdrawing Megace. I do not prescribe the use of Megace in prostate cancer patients (even for hot flashes), because I don’t know who has a mutant and who doesn’t."

Men on ADT often ask “What is causing these hot flashes?” Some attribute the cause simply to loss of testosterone. I believe it is more complex than just this loss. Consider that when men have surgical castration/orchiectomy and can no longer produce testicular testosterone, though they may experience hot flashes, they are found to be much more subdued than those experienced by men when chemical castration is prescribed. As noted in one paper regarding LHRH agonists, “Hot flashes, similar to those which occur in women during menopause, are common and can often be more pronounced than those observed in patients who are treated by surgical orchiectomy.

Other past reports indicated “Hot flashes are thought to result from an alteration in the feedback mechanism to the hypothalamus due to the lack of testosterone. An increase in catecholamine secretion in response to decreased endogenous peptide secretion stimulates the nearby thermoregulatory center of the hypothalamus, resulting in the perception of increased heat.” This would indicate that it is the effect from the LHRH agonist on the hypothalamus that brings about this “alteration.”

Another cause can be attributed to LHRH agonist effect on lowering male estrogen levels, since low estrogen levels also bring about hot flashes. Patients on transdermal estradiol (TDE) therapy did not experience hot flashes.

It's not really understood how reducing testosterone brings on hot flashes. However, it's true that hot flashes are a common side effect of LHRH agonist therapy. Hot flashes can range from annoying to debilitating. Sometimes hot flashes are associated with facial flushing, redness, and increased sweating and may cause nausea or interruption of sleep. Hot flashes can be brought on by stress or heat, or they may occur for no apparent reason at all. Studies have shown that the majority of the hot flashes that men experience as a side effect of ELIGARD therapy are typically mild.

Researchers analyzed patient characteristics and their DNA to determine which factors were associated with an increase in hot flashes. They discovered that men who were younger and had a lower body mass index experienced more hot flashes and felt more interference with their daily lives. The researchers also reported that the presence of certain genes involved in processes such as immune function, nerve impulse transmission, blood vessel constriction, and circadian rhythms were associated with an increased number of hot flashes.

You might want to print this post then discuss with your family physician, your urologist, or your oncologist, particularly for those requiring a prescription. On the other hand, you might just want to print it out, hang it on the wall, throw a dart at it, and give the result of the dart point a try. If that doesn't work, throw another dart. Hopefully, eventually the dart will connect with the one that will work for you. In the meantime you will be enjoying yourself so much throwing darts that you'll forget about the hot flashes/flushes! 😊

25 Replies
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Chuck, I am glad that you are back to posting. I have always found your postings to be informative. I hope, you have many years with us.

Rich, a member of the Reluctant Brotherhood

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Chuck it must be two years now since you last posted and as ever this post is so informative. Welcome back and please stay a while

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I have been so busy monitoring other prostate cancer related websites, responding to patient or caregiver personal emails, continuing research and study of our insidious men's disease, that I haven't really broadened into monitoring others like HealthUnlocked. However, I will try to occasionally take a look at posts and respond if I think the person posting could use more info than provided by other who respond.

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Great to hear from you again Chuck!!!

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Great to hear from you Chuck. You are the best Thank you Brad

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I used to have wicked hot flashes, on average one every hour. At first I took it as reassurance that the ADT treatment was working but it got old after a while. Dr. Myers prescribed estradiol patches and it greatly reduced the frequency of hot flashes, worked like a charm. I still get them from time to time but nowhere near as often.

Ed

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And estradiol is another product that can help; problem is, few physicians are familiar with proper prescribing and use of estradiol patches.

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I have been on Magace for the duration. Personally ill chuck all my other meds in the trash before i go without my Magace. I guess it hasnt made my cancer spike after 8 years but who knows, i just recently went mcrpc in march.

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And what has been determined the reason you are now experiencing metastatic castration-resistant prostate cancer (mCRPC)?

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Normal progression.

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And definitely Megace was not found to have possibly been among the culprits? Point is, we just don't know, and that is why Megace is considered a medication to NOT take when one is dealing with prostate cancer.

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Since diagnosed at stage 4 with pelvic involvement i think i am lucky to have went 7 years. Im not giving my magace up. It works to good.

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I will never argue with the patient. I am merely the messenger of what research has determined. The choice is certainly yours, but I would suggest you bring to the attention of your mCRPC physician what has been suggested to you to recognize regarding Megace and its relation to prostate cancer activity.

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Problem is when cancer mutates, certain products can begin to feed the cancer, As Dr. Oliver Sartor a leading researcher in prostate cancer has stated he has actually seen a withdrawl response ,meaning a psa drop and continued response to adt when megace was withdrawn. I had a withdraw response to estrogen, after it working for years.

1. You probally do not even get hot flashes after 7 years.

2. Is it not worth stopping megace to see if you get a response?

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I tried stopping it once about 18 months ago. The hot flashes returned almost immediately.

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I found a simlilar statement by Dr. Strum was in a comment to the article

ADT, Apalutamide and Exercise in the Treatment of Prostate Cancer

drgeo.com/adt-apalutamide-a...

"Some men experience severe hot flashes and one injection of deep-provera 400 mg i.m. often completely knocks out this symptom; but it should only be used if symptoms are moderate to severe. Twenty years ago we published an abstract in ASCO (American Society of Clinical Oncology): Strum SB, Scholz MC, McDermed JE: The Androgen Deprivation

Syndrome: the incidence and severity in prostate cancer patients receiving

hormone blockade. Proc Amer Soc Clin Oncol 17:316A, 1998. If there is interest I can post that abstract in a separate comment."

Bold emphasis added.

I'm using gabapentin to control severe hot flashes, bad enough to wake me several times a night. Poor sleep quality exacerbates the many toxicities associated with ADT.

I started at 100 mg gabapentin at bedtime, which worked for a few days, but the hot flashes returned. Following my doctor's recommendation, I add another 100 mg capsule every 2 days as needed to control the hot flashes. Currently I'm on 400 mg per night and it seems to be working.

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I just lived with it. Women do, so why couldn’t I.

Takes about 4 years to get through them, but they get milder gradually after about 30 months.

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Right on Tommy, I always knew the hot flash meant the adt was working, I bought a hand held fan and a floor model, cranked the ac. Women do live with it, all of them post menopause.

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Just to add to this thread, hot flash severity for men on ADT is age dependent and typically more several for younger men. [References from the medical literature are in the ADT book.]

Also there is a a clinical trial underway in Australia looking at using low dose transdermal estradiol to manage hot flash severity. It will likely document what is already known for menopausal women and anecdotally for PCa patient (e.g., from the PATCH study currently underway in the UK, of example). Using some add-back non-oral estradiol would be the most natural way for PCa patients it reduce or avoid hot flashes.

The cautionary note that I'd add to that is that the use of estradiol may not be recommended if one is in the realm of being castrate resistant or has estrogen sensitive PCa, such as BRCA mutations. As noted in this thread, this is a topic to discuss with your physicians.

LIFEonADT.com

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In my past saved information, Medical Oncologist Charles E. "Snuffy" Myers was prescribing estradiol patches at a 0.025 dose Vivelle dot patch changed every 3 ½ days.

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Was prescribed 600mg Gabapentin for foot neuropathy. Hasn't done anything for that, but almost all hot flashes went away. Could be that Central Valley in California was 100 degrees or more for 30 straight days (new record. yea!) and I was so miserable that I simply didn't notice them anymore. A little groggy the 1st couple of mornings but that went away. I have not yet had the urge to leap out of a tall building in a single bound. Your results may vary.

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to maack1:

Hot Flash for you... I couldn't find my darts so I used my 12 gauge double barrel shot gun instead, blew the damn paper right off the wall. Cooler now with that big hole in my kitchen wall, it's helping with the flashes though. Thanks...

Good Luck and Good Health.

j-o-h-n Wednesday 08/29/2018 5:56 PM EDT

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There ya go j-o-h-n, never thunk of that! :-)

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Great to read your post, Chuck.

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Welcome back to HealthUnlocked Chuck!

Alan

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