Dear Dr. Roach: My husband successfully completed 45 days of radiation for prostate cancer. His last PSA was non-detectable. He has to take medication for two years as part of the cure. However, it is causing him to have horrible hot flashes and night sweats. The usual over-the-counter solutions for women do not seem to be helping at all. Would you suggest something designed for a male? — P.B.
Answer: The first effective treatment for prostate cancer was depriving the cancer cells of androgens, which was initially done surgically, by removing the testes. It is done now with medications that act like gonadotropin-releasing hormone. Although these initially stimulate testosterone production, their continued use causes lower levels of testosterone, and within a month testosterone levels drop to the same levels as in men who have had surgery to remove their testes.
Hot flashes occur in 80% of men and can be very disruptive. Treatments that are effective for women are often not effective in men, as you observed. The best-studied and most effective treatments in men were medroxyprogesterone (a hormone that opposes some actions of estrogen) and cyproterone (an antiandrogen available in Canada, but not the U.S.). It reduced hot flashes by 84% to 95% in men. Venlafaxine, normally used as an antidepressant, reduced symptoms by 50%, and gabapentin, used for epilepsy or for nerve pain, reduced symptoms by about 45%.