I started ADT + Casodex in November 2018 for my metastatic PCa in many pelvic and abdominal lymph nodes. Previously, I had Firmagon (three months) and two 3 month Lupron shots in 2016-2017 for extra-capsular- extension. In 2016, after the first Firmagon shot I had severe hot flushes, which gradually became manageable during the next two Firmagon and six months of Lupron.
This time, after the first Lupron shot in November 2018, I had strong hot flushes that settled down gradually. But after the third shot, the hot flushes became stronger towards the end of three months. I had the fourth shot on September 9. Suddenly, my hot flushes became very intense and I am having more than ten flushes a day.
My PSA before the first Lupron shot was 4.48. It went down to 0.17 in March, 0.1 in June, and 0.07 in September. By now, I may have reached PSA nadir and I am expected to stay there as long as ADT + Casodex works.
My question is why my hot flushes have become stronger after nine months. Does it have any significance regarding effectiveness of the treatment? I would like to hear similar experience from others. Particularly, those who became castrate resistant.
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dac500
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It is not related with the effectiveness of the ADT.
Here is a section of a review regarding hot flushes:
Hot flushes
Hot flushes affect over 50% of men receiving ADT (Charig & Rundle 1989, Schow et al. 1998, Sarosdy et al. 1999). They are a result of the abrupt withdrawal of sex hormones from the circulation, which lowers the temperature set-point in the pre-optic area of the anterior hypothalamus thus causing the peripheral thermoregulatory mechanisms to be activated inappropriately. Noted triggers include increased ambient temperature, stress, anxiety, certain foods and alcohol.
Described as an uncomfortable sensation of heat or sweating that can even be associated with extreme distress, light-headiness, palpitations and marked sleep disturbances; hot flushes are a major contributor to the discontinuation of ADT. Whilst flushes may wane over time this is not always the case with some men continuing to experience symptoms over a number of years (Karling et al. 1994).
It is important that the treating practitioner recognises the frequency of this adverse effect and specifically asks all patients regarding this symptom. Usually a simple explanation will do much to alleviate anxiety and is all that is required along with simple lifestyle modifications such as the avoidance of trigger factors, maintenance of a healthy body weight, regular exercise and the use of appropriate clothing, particularly at night.
However, sometimes other strategies need to be employed, such as the use of non-hormonal therapies including selective serotonin reuptake inhibitors (Quella et al. 1999), clonidine (Loprinzi et al. 1994), or gabapentin (Loprinzi et al. 2009) or hormonal therapies such as cyproterone acetate, medroxyprogesterone acetate or diethylstilbesterol (Irani et al. 2010). Acupuncture and relaxation techniques (Beer et al. 2010, Ashamalla et al. 2011) may also be considered.
All these methods are variably effective with their own set of side effects making a short-term trial approach, usually of up to 4 weeks duration for each agent alone or in combination, necessary (Quella et al. 1999, Loprinzi et al. 2009).
I have always judged the efficacy of ADT drugs by hot flashes. I had flashes for years on casodex. I will never forget my initial response to xtandi. I woke up one morning drenched in sweat head to toe. The sheets were drenched, I was drenched. But my PSA took a real nose dive.
8 months in on ADT ans immediately needed relief from Hot Flashes. I have made them tolerable by taking 75 mg of Venlafaxine (prescription from MO) along with 540 mg Black Cohosh (OTC Supplement). I also take 12 mg of Melatonin to help sleep through the night. This combo has helped immensely.
Best Wishes,
Jim
Hot flashes can really vary from person to person. It's not the hot flashes, it's the testosterone level that matters. As long as the T is at castrate level, primary ADT is working as well as it can.
For me, hot flashes and night sweats don't exactly correlate. For the first couple of months following ADT initiation, night sweats were frequent and substantial (e.g., PJs soaked and bed sheets wet). But hot flashes were infrequent and mild. Then night sweats decreased and hot flashes slowly increased. Now, at nine months, no night sweats but fairly frequent and substantial hot flashes (which aren't fun, but aren't debilitating). So, as we know, ADT effects are different for different guys.
14 months on Lupron. PSA down from 1300+ to<2. Hot flashes frequent, day and night entire time. Requires layering and unlayering clothing and turning on off fan. Got remote control to help.
But, hey, the alternative much worse. Just enjoying the ride while I can...
I had intense hot flashes, I counted 15 per day! Dr. Myers started me on Estradiol patches almost 5 years ago, works like a charm. I still get them here and there but nothing like what I was experiencing.
I had intense hot flashes just weeks after starting Lupron, with intense sweating. Roughly once per hour. They have dissipated over time, they don't come on like a heat bomb, and are less frequent. I started Lupron Dec of 2018
The key is to do intermittent ADT to keep it working otherwise you'll develop CRPC in 18 months and be in real trouble. I've done that for over 7 years and PSA is stable at 3.1 from 48.
Both my night sweats and hot flushes have been overall less frequent after the first year (first year was pretty bonkers but I was also completely stressed out so anxiety didn't help). My thermostat seems to go a bit bonkers (cold and hot) the first week after Lupron injections though. I do a fair amount of public speaking I've had to learn to just let my audience know I'm on a med that gives me hot flashes if I happen to have a hot flash while being "on stage". Post menapausel women always get a kick out of it and, either way, just putting it "out there" ensures that I don't have anxiety-induced stress on top of it and it goes away quickly. Exercise and limited alcohol consumption have minimized my flashes too. If you work at a desk, a little desk fan is great if the air gets a bit stagnant. Hang in there!
I was originally on intermittent ADT for first 5 years, along with intermittent zytiga for most of those 5 years. I have been on continuous ADT for last 2 years without Zytiga. I still get the hot flashes but they are less intense then they were in the earlier years and less frequent.
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