Hot Flush Treatments
Posted: Sun Feb 10, 2002 3:27 am
I saw my Urologist yesterday. He gave me a handout about this problem. I am on vacation 10-18 February. I see him again on 19 February to start treatment for hot flushes IF I choose to do so. I am still dithering on the question. Here is part of the handout. I ommoted sections on less successful treatments.
The following is reprinted from a two page handout I received from Dr. Wolk, my Urologist.
INTRODUCTION: Hot flashes, flushing or hot flushes are synonymous words for the episodes of sensation of increased warmth usually in the upper body and face. Technically, hot flushes is the correct term but hot flashes seems to be commonly used.
Hot flushing occurs with a reddening of the skin and often with sweating. The episodes may last anywhere from seconds to many minutes, but usually last only two or three minutes. Most of the time the episodes occur without cause; but in some men can be triggered by changes in position, ingestion of hot fluids, or changes in outside temperature. Hot flushes occur in two-thirds of the men who receive drugs which inhibit the production of male hormone, and at least 50% of the men who have undergone removal of the testicles.
In many patients the incidence of hot flushes decrease over time, but unfortunately in some other patients the flushing continues unabated for years.
FEMALE HORMONES: One of the most common treatments historically for hot flushes is to use a female hormone, usually diethylstilbestrol or ΒStilbestrolΒ. Given in low doses (even as low as 0.25 mg/day) this is at least 70% effective in treating hot flushes. Unfortunately, the female hormone causes breast swelling or tenderness in almost all patients. More importantly the use of Stilbestrol may increase the risk of heart attack or stroke. Many of the reports do suggest at low doses these significant side effects do not occur and may be prevented by the use of aspirin or other blood thinners. In patients who are at high risk for heart attack or stroke, the use of Stilbestrol must be questioned, but it is probably the simplest and least expensive way of treating the problem.
If breast enlargement and tenderness is a concern, the patient can undergo radiation treatments for three days to the breast area prior to treatment, which usually helps significantly in preventing symptoms or changes.
MEGACE: Another drug called megestrol acetate (Megace) is almost as effective. Using 20 mg tablets twice a day, as many as 70% of men will have relief of their hot flushes. The megestrol acetate has a very similar response rate to Stilbestrol and was associated also with very few side effects. In some women using large doses of megestrol acetate, retention of water was seen with edema of the legs. This has not been seen usually in the doses used in men being treated for hot flushes. Unfortunately, the drug is significantly more expensive and may cause weight gain from fluid retention.
SUMMERY: As long as the reduction of male hormones remains a primary treatment for extensive prostate cancer, hot flushes will continue to be a problem. The treatments of choice at this point remain somewhat controversial, but we would probably start with megestrol acetate, 20 mg twice a day and, if effective, continually lower the dose down slowly to the lowest effective dose.
If this is not effective, then the use of diethylstilbestrol starting at 1.0 mg per day and slowly changing the dosage up or down to find the lowest but effective dose. However, diethylstilbestrol is used with the understanding that breast tenderness and a possible increased rate of stroke or heart attack might result.
The following is reprinted from a two page handout I received from Dr. Wolk, my Urologist.INTRODUCTION: Hot flashes, flushing or hot flushes are synonymous words for the episodes of sensation of increased warmth usually in the upper body and face. Technically, hot flushes is the correct term but hot flashes seems to be commonly used.
Hot flushing occurs with a reddening of the skin and often with sweating. The episodes may last anywhere from seconds to many minutes, but usually last only two or three minutes. Most of the time the episodes occur without cause; but in some men can be triggered by changes in position, ingestion of hot fluids, or changes in outside temperature. Hot flushes occur in two-thirds of the men who receive drugs which inhibit the production of male hormone, and at least 50% of the men who have undergone removal of the testicles.
In many patients the incidence of hot flushes decrease over time, but unfortunately in some other patients the flushing continues unabated for years.
FEMALE HORMONES: One of the most common treatments historically for hot flushes is to use a female hormone, usually diethylstilbestrol or ΒStilbestrolΒ. Given in low doses (even as low as 0.25 mg/day) this is at least 70% effective in treating hot flushes. Unfortunately, the female hormone causes breast swelling or tenderness in almost all patients. More importantly the use of Stilbestrol may increase the risk of heart attack or stroke. Many of the reports do suggest at low doses these significant side effects do not occur and may be prevented by the use of aspirin or other blood thinners. In patients who are at high risk for heart attack or stroke, the use of Stilbestrol must be questioned, but it is probably the simplest and least expensive way of treating the problem.
If breast enlargement and tenderness is a concern, the patient can undergo radiation treatments for three days to the breast area prior to treatment, which usually helps significantly in preventing symptoms or changes.
MEGACE: Another drug called megestrol acetate (Megace) is almost as effective. Using 20 mg tablets twice a day, as many as 70% of men will have relief of their hot flushes. The megestrol acetate has a very similar response rate to Stilbestrol and was associated also with very few side effects. In some women using large doses of megestrol acetate, retention of water was seen with edema of the legs. This has not been seen usually in the doses used in men being treated for hot flushes. Unfortunately, the drug is significantly more expensive and may cause weight gain from fluid retention.
SUMMERY: As long as the reduction of male hormones remains a primary treatment for extensive prostate cancer, hot flushes will continue to be a problem. The treatments of choice at this point remain somewhat controversial, but we would probably start with megestrol acetate, 20 mg twice a day and, if effective, continually lower the dose down slowly to the lowest effective dose.
If this is not effective, then the use of diethylstilbestrol starting at 1.0 mg per day and slowly changing the dosage up or down to find the lowest but effective dose. However, diethylstilbestrol is used with the understanding that breast tenderness and a possible increased rate of stroke or heart attack might result.
