The management of hot flushes for men treated with androgen deprivation therapy for prostate cancer: a survey of UK practice

Abstract

Androgen deprivation therapy (ADT) is one of the main treatments for prostate cancer. Short-term ADT of between 6 months and 3 years is often used in combination with radiotherapy to treat localised and locally advanced prostate cancer. Permanent or intermittent ADT is used to treat metastatic disease. Hot flushes affect 44-80% of men undergoing ADT for prostate cancer, with around 27% saying they are the most distressing side effect.1 A recent UK survey found 30.7% of men treated with ADT reported moderate or major problems with hot flushes.2 Low testosterone levels are thought to cause dysfunction in thermoregulation in the hypothalamus, resulting in peripheral vasodilatation.3 Symptoms include a feeling of warmth, flushing of the skin, perspiration, chills, anxiety and palpitations. A variety of treatments have been evaluated and there is evidence of efficacy for several of them, however they all have additional side effect profiles. The National Institute for Health and Care Excellence (NICE) and European Association of Urology recommend offering medroxyprogesterone or cyproterone acetate.4-5 NICE has said there is currently a lack of evidence to support the use of complementary therapies. Addressing the side-effects of cancer treatment is one of the top ten Living with and Beyond Cancer research priorities established by the National Cancer Research Institute. However, there is little evidence on the standard of care that UK clinicians offer to men suffering with hot flushes.