You misunderstand why Prednisone is given with Zytiga. Zytiga impairs the adrenal glands' ability to manufacture cortisol. So you have to REPLACE what was lost. The dose of prednisone is very low - it only replaces what is lost. If you don't use it, you will suffer certain symptoms, due to ACTH excess, including hypertension, hypokalemia, and fluid retention. You are not taking enough prednisone to cause symptoms related to cortisol excess.

You are taking prednisone to replace the amount manufactured during natural circadian rhythms. Hot flashes also occur during the natural circadian rhythms of body temperature. So the effect you observe is not causal.

Oxybutynin is given for bladder spasms. I'm not sure why it works for hot flashes, but it seems to. If you want to avoid taking another pill, acupuncture has reduced hot flashes in randomized clinical trials. Effexor has also shown some efficacy. Estrogen patches are very effective taken with tamoxifen to prevent gynecomastia.

My first inclination is to suggest that you keep getting your head around the idea that you and yours are in this for the long term, regardless of how long any individual treatment may actually work. With advanced disease and treatments that lower Testosterone, you will likely be dealing with some level of hot flashes and other side effects indefinitely.

After a while, your peak energy, stamina, and ability to work in the heat may continue to decline, despite your best efforts to stay active, eat a generally healthy diet, and do some good intentional exercising. You may want to start thinking now about your eventual transition away from the kinds of roles and work you have been doing, and transition to other things that may bring you other practical benefits and different satisfactions. Explore your future options and timing considerations for a possibly reduced work load, or a transition to another less demanding job, or a possible disability claim, or an earlier retirement, or some down-sizings, and similar transitions of potential insurance coverages as you continue to live with your disease. Maybe do some estate planning, too. Maybe not all right away or all at once, but sooner rather than later. Some of the time during your current initial treatment might be a good time to start thinking along such lines.

Don't be surprised if just going through some of these kinds of things generates some perfectly normal emotions of sadness over the thought of losing former capabilities and filling former roles due to the combination of your disease + normal aging. It can also bring a sense of positive control, accomplishment, and intangible satisfaction.

Just some thoughts...

Charles

Was prescribed 600 mg Gabapentin for foot neuropathy. Didn't seem to do anything for that, but hot flashes almost all went away.

I don’t know what you have read, but as a person who took 30 mg of Prednisone a day, 20 mg in morning and 10 mg 12 hours later for 180 days ( six months), I was told by my research Medical Oncologist, that Prednisone has PCa cell killing properties. During this period, I had weekly blood draws. Armed with three pages of results, he was the best guy to see how my body was reacting. Results that a Pharmacist never saw. I was told up front that I could expect weight gain. And sure enough, over the six month trial, I gained 80 pounds from the Prednisone and Eligard/Lupron injections. Small price to pay, to kill this bastard disease in my opinion. Gain the weight, then take it off through diet and exercise. I my case, that meant three workouts a week with a Personal Trainer several years later. Why didn’t I do this immediately? I was fatigued from all the drugs administered to kill cancer cells.

I also was told to stay out of the Texas heat in the summer. Wondered why until all strength was zapped. You might discuss 100+ heat and your cancer treatment with your Oncologist and Cardiologist. I believe that you are dealing with known side effects and not understanding the impact that cancer drugs play on your weakened system.

Results. I started my journey at 187 pounds 15 years ago, ballooned up to 299 pounds. Today at age 71, I am 225 pounds. My Cardiologist says 220-225 pounds is a good weight considering where I was and all of the drug induced effects on my body.

Question, are you sure that the bulk of your hot flashes are not derived from Lupron? I experienced them for the six year period that I was on Lupron, but the eventually faded away as my body adjusted to hormone injections about two years later. Good luck in killing this bastard.

PS. In reflection, as I aged, my physically activity aged also. I stopped fighting wars and surfing at 27; stopped playing fast pitch softball at 40; stopped climbing at 55; damn near stopped all physical activity including mowing the grass at 57 and concentrated on killing cancer and less strenuous activities. Right or wrong, it is what I did.

My advice, deal with your cancer and understand the changes that your body is going through. Age and time in treatment is really insignificant.

Keep killing the bastard. Stay positive.

Gourd Dancer

My Stanford doc told me, when I challenged her regarding the same thing, that prednisone was used to replace the steroids you are losing due to the Zytiga. I wanted to stop this too but they said absolutely not.

Taking Zytiga + Prednisone + Trelstar injections 4 yrs now. Side effects manageable but annoying. Hot flashes/sweats tiredness and muscle loss. All the best

In future treatments👍🏻