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! 😊
Hot Flashes Long Time After Last ADT Shot
Hot Flashes
ESMO 2024: Phase 3 evaluation of transdermal estradiol vs LHRH agonists for androgen suppression 
