Management of hot flushes due to endocrine therapy for prostate carcinoma

Endocrine manipulation plays a crucial role in the treatment of advanced prostate carcinoma. Recent enthusiasm for earlier use of endocrine therapy has increased the significance of diminishing treatment-related side effects, particularly vasomotor hot flushes, to ensure long-term patient compliance. Treatments that lower serum testosterone, such as orchiectomy or luteinizing hormone-releasing hormone (LHRH) analogs, cause hot flushes in over half of men. Lack of regulatory feedback in the hypothalamus from circulating serum testosterone is the presumed mechanism of hot flushes in these men. Most often, hot flushes are only mildly bothersome and can be tolerated without the need for treatment. However, if flushes are particularly annoying or problematic, treatment should be offered. Small doses of diethylstilbestrol (DES) are effective in relieving hot flushes but cause gynecomastia. Megestrol acetate, at a dose of 20 mg bid, completely eliminates hot flushes in most men, and the dose can be progressively lowered in some.