Treatment Side Effects - Hot Flashes

Hot flashes are a sensation generally associated with women who are undergoing menopause, however, men being treated for prostate cancer have the potential to develop hot flashes (also called hot flushes) as well. Specifically, it has been estimated that roughly 80% of men utilizing androgen deprivation therapy (ADT or hormonal therapy) for their cancer experience hot flashes. Of these men, almost 30% report that their hot flashes are the most troublesome side-effect of treatment.¹ Hot flashes can last anywhere from 2 to 30 minutes, and some of their most common characteristics include:

• Feeling a warm sensation in your face or neck that can spread throughout your body
• Sweating
• Feeling panicked or irritable
• Reddening of the skin
• Heart palpitations (feeling your heart beating in your chest)²

Not all men will experience hot flashes, and of those who do, not all will need or want to seek treatment. How you decide to manage, or not to manage, your hot flashes is completely up to you. If you do wish to seek treatment for your hot flashes, consult your doctor first.

Why hot flashes?

Men on hormone therapy or ADT for prostate cancer are at risk of developing hot flashes. The exact mechanism by which men develop hot flashes is not completely understood, however, it has been hypothesized that the decrease in testosterone levels and changes in norepinephrine levels after taking a LHRH agonist or other specific hormone therapy may contribute to the development of hot flashes.^1-3 Additionally, surgical removal of the testicles (orchiectomy) as a form of hormone therapy, and medications like steroids may also lead to the sensation. These hot flashes typically last for as long as a man is utilizing hormone therapy, however, in cases where hormone therapy is palliative (used indefinitely for symptom management) or permanent (orchiectomy), hot flashes can last the rest of a man’s life.

Managing hot flashes

There are multiple ways to manage hot flashes that are both medication-based and lifestyle-change based. Talk to your doctor if you are interested in managing your hot flashes with medications. Not all men will be able to utilize all of the potential medication options. Your doctor will help you determine which options are most appropriate for you. Common medications used to treat hot flashes in men include:

• Estrogens
• Progestin, including medroxyprogesterone (Provera)
• Antidepressants, including Effexor and Zoloft
• Anticonvulsants, including Gabapentin (Neurontin)
• Clonidine (a drug used to treat high blood pressure)^1,2,4

It is important to note that not all of these medications will be suitable or tolerable for everyone. Also, several of these medications can carry severe side-effects. Talk to your doctor before starting medication for your hot flashes, and disclose your full medical history and any other medications, vitamins, or supplements you are taking.

In addition to medication-based treatment options, there are also several lifestyle or behavioral changes an individual can make to help manage their hot flashes, including:

• Trying to remain in a cool environment as much as possible
• Use a fan when available
• Wear light layers of clothing that can be taken off during a hot flash if needed
• Layer your bedding so you can remove layers as necessary during the night
• Utilize cooling pads
• Practice deep breathing and relaxation techniques (including hypnosis or acupuncture) to reduce stress
• Sleep or sit on a towel if you are sweating a lot
• Avoid hot showers and baths
• Wear natural, breathable fabrics
• Eat a healthy, balanced diet
• Avoid caffeine, alcohol, and tea
• Cut out nicotine products or stop smoking^1,2,4

Talking about your experience with hot flashes

Despite being very common for men undergoing treatment for prostate cancer, experiencing hot flashes can feel embarrassing and frustrating at times. Because of this, it’s common for men to avoid talking about these struggles with their doctors or partners. By not talking about these issues, feelings of frustration, anxiety, or even depression may build up, and lead to significant impacts on a man’s overall wellbeing. For this reason, if you are struggling, it is critical to talk with your doctor about potential treatment options that may be right for you, or for specific tips on how to manage what is going on. How much you share about your hot flashes is completely up to you, however, enlisting the support of an intimate partner, spouse, or close confidant may help ease the burden and ensure you that you are not alone.