April 28th, 2011
09:16 AM ET

What are the symptoms of prostate cancer hormone therapy?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by Diana of Norfolk:

My husband has non-Hodgkins lymphoma, stage 4, and has been treated with chemotherapy. His doctor says it is under control. He wonders does that mean it is gone or just being held at bay? He has been having "hot flashes" since he began his treatment for his prostate cancer (cannot remember the Gleason score, but tumor was in both lobes of prostate, without changes to his bone marrow.) He was treated with hormones, brachytherapy and radiation for this. We can't seem to get an answer for the question of the "hot flashes." Are they a symptom of ongoing disease, the hormone therapy or will he just continue to have them for the rest of his life?

Expert answer:

Dear Diana,

I worry that you and your husband cannot get information from his physician. Ideally, doctors should have time to sit down and explain things to their patients. I am sorry that is not happening. I encourage you to try again, but I do realize that you may not be able to get a good conversation with him/her. I also know that you may not be able to change doctors, which is what I recommend when patients find that they cannot communicate with their doctor.

I do not have a lot of details about your husband, but I can tell you a few things. Lymphomas are cancers of the immune system. They are first categorized as Hodgkin's lymphomas or non-Hodgkin's lymphoma (NHL). There are at least five types of Hodgkin's lymphoma and in some systems more than 20 types of non-Hodgkin's lymphomas. Stage 4 means the lymphoma has spread to places far from its origin. Some NHLs will respond to chemotherapy by totally disappearing, meaning there is no evidence of disease when we do radiologic imaging with X-rays, CT scans, or MRI.

If the disease was initially in his bone marrow, no evidence of disease also means the bone marrow has been re-biopsied and it appears not to have disease in it. In all cases, no evidence of disease means "no evidence." There may be some disease that is not detectable. Some patients with this status will relapse, meaning the disease grows back and it will eventually be a size in which it can be seen. They will have to be retreated with a different chemotherapy.

There are some NHLs that never really go away. These cancers are generally slow growing, sometimes referred to as indolent or nodular lymphomas. These cancers are often observed for a time after diagnosis and are treated with chemotherapy or radiation if they seem to be threatening the function of a vital organ or seem to begin growing quickly. These cancers frequently do not go away with treatment, but they can just quiet down and still be seen on radiologic imaging for sometimes years.

The prostate cancer is a different cancer altogether. It is not related to the NHL. Locally advanced prostate cancer, meaning cancer in the prostate that may have spread to the area just outside the prostate but is still confined to the pelvis, is often treated with radiation and hormonal therapy.

Doctors use a combination of external beam radiation with hormonal therapy and they may add brachytherapy, in which radioactive material is inserted into body cavities or tumors. A few are treated with brachytherapy and hormonal therapy without external beam radiation. One of the few areas in prostate cancer where we have good studies is the treatment of locally advanced prostate cancer. Several studies show an improved outcome in these men when they get radiation therapy along with hormonal therapy.

External beam radiation involves a radiation machine shooting radiation at the prostate for several minutes on a daily basis for a number of sessions over three to sometimes eight weeks.

Brachytherapy is sometimes done after the external beam radiation. It uses radioactive rice-sized seeds (usually made of radioactive iodine or palladium). Generally, 80 to 120 seeds are permanently placed in the prostate in a one-time surgical procedure. Hormonal therapy is given, generally by an injection, starting two to three months before the radiation begins and is continued for six months to two years after the radiation ends. The hormonal injection can be monthly, or every three or four months or longer.

The hormonal injection commonly causes hot flashes and sweating, breast tenderness, muscle loss, osteoporosis, headache and depressed mood. Indeed, hot flashes are seen in the majority of men getting hormonal therapy for prostate cancer. They also increase risk of diabetes mellitus, myocardial infarction and stroke.

There are some therapies that can be administered to alleviate the hot flashes. I have especially been impressed by acupuncture for the treatment of hot flashes. Several drug therapies are also used with some success. Also, a patient taking hormonal therapy for prostate cancer should be considered for treatments to prevent osteoporosis, cardiovascular disease and stroke.

soundoff (28 Responses)
  1. Prostate Doc

    While hot flashes can be very uncomfortable they are very treatable. A bigger concern often not discussed with patients is the risk to the heart that hormonal therapy can pose:


    Prostate Doc

    April 28, 2011 at 09:26 | Report abuse | Reply
    • Deedz

      There are so many natural alternatives, why take a risk with HRT

      April 28, 2011 at 12:28 | Report abuse |
    • carashere

      Deedz, read the article. No one is talking about HRT.

      April 28, 2011 at 14:08 | Report abuse |
    • Mary

      Revival Soy! I can't sing its praises loud enough!!!

      It's a powder that takes on the flavor of whatever food you cook it in, or the flavor of whatever you blend it with as a shake. I blend Vanilla Revival Soy (my daughter loves the chocolate flavor) with a can of Butter Pecan Ensure (or very Vanilla Soy Milk), 2 bananas, a scoop of pecans and/or walnuts and a dollop of syrup from wet walnuts ice cream topping. Blend well and freeze to almost milk shake consistency. Blend again and drink. Absolutely delicious and after 30 days of consistent use, hot flashes are gone.

      Granted, I use them for menopausal hot flashes but I'm almost willing to bet that it will alleviate hot flashes related to cancer treatments and recovery. At least it's a natural remedy that will either taste very good and/or help, versus the potential harms of hormone therapy.

      April 29, 2011 at 09:59 | Report abuse |
  2. carolae

    I never knew what all the commotion was about when women would complain about their hot flashes. I started mine at the age of 40 and within a year, they were over. I got hot....then I got cold....so what! I never had to take any meds for this. PLUS...I was living in AZ at the time and it was during the summer! Since I tend to be on the cold side all the time, a hot flash was welcomed. Women today are making far too much out of these hot flashes. Some even have them for years....God forbid they should try to get on with their life and take all the pills to stay cool! One of the problems is if you are way over weight....that only makes it worse as I know a number of heavy set women in their 50's who have had them for years. Just think of it as another challenge and let nature take its course.

    April 28, 2011 at 10:14 | Report abuse | Reply
    • lingfing

      How compassionate. Your hot flashes weren't severe so nobody else's can be and if they are, those women must be overweight (I'm not). My hot flashes (the first time around, 10 years ago) were moderate. I woke up at night with sweat pouring off me and I was lying in a wet bed. This time around (I think I'm finally going through menopause), they aren't that bad. I've never taken medication for mine, but I'd never tell another woman hers aren't severe. I had PMS and it was severe. Other women thought I was exaggerating, but I was almost murderous. My labours were severely painful (not to mention long–my second labour was 60 hours long). A friend had labours that she considered "uncomfortable". We're all different and it's not just a matter of being a wimp. Our bodies do react differently.

      April 28, 2011 at 11:38 | Report abuse |
    • carashere

      Did anybody read the article? This is not about menopause, it's about the side effects of men's prostate cancer treatments!

      April 28, 2011 at 14:10 | Report abuse |
    • Chartreux

      Indeed. Well, thanks for sharing that, Carolae. You've been very fortunate. Mine were so bad I'd wake up with dripping wet hair. I had to get up and towel off, change the sheets and do this 3-4x each night. In addition fluctuating hormone levels gave me regular blinding migraines, 4-5+ times weekly. Think lack of sleep made me cross and irritable, never mind the other symptoms? Oh, yes, they did.

      Everyone is not like you. Experiences and symptoms vary widely. If you're lucky enough to live through your life without ever having cancer, do you then believe that no one else will ever suffer from cancer? Believing your menopause symptoms are the norm is similar in naivete. Ge a clue, get some more education or find more female friends. For some of us menopause is hell. Having someone like you tell us 'let nature take its course' gives us homicidal feelings. Perhaps you should mind your own business since you don't have a clue what you're talking about.

      April 29, 2011 at 09:08 | Report abuse |
  3. Roonie

    You say there are drug therapies for hot flashes? Please specify. What relief can you recommend to alleviate hot flashes that persist for over five years, as a daily occurance, resulting from chemotherapy ("chemopause")? These episodes are every half hour, daily, and no physician has had any insights how to treat or cure them. Your help would be appreciated!

    April 28, 2011 at 11:38 | Report abuse | Reply
    • Cheryl

      I too have had extended problems with hot flashes. I have found relief with Amberen – available online. I had to use double dose at first but now can use regular dosing.

      April 28, 2011 at 11:57 | Report abuse |
  4. Gigi

    In response to Carolae...very nice that you didn't have severe hot flashes. I also started at 40 yrs old and they completely disrupted my life. I would have approx. 3 per hour that lasted 5 mins each – day and night. I could not function at work. Once I went on the pill it was manageable. As Lingfing says...not every body reacts the same so please don't pass judgment on others.

    April 28, 2011 at 12:16 | Report abuse | Reply
    • Chartreux

      I was 37. It was hell.

      April 29, 2011 at 09:09 | Report abuse |
  5. williama

    Roonie – my physician started me on effexor & I could tell the difference within a couple of days! Effexor is normally prescribed for depression/anxiety, but has been found effective in reducing hot flashes. I take a low dose daily and now my hot flashes are down to once or twice a week. What works for some won't for others, buy you might want to discuss it with your doctor.

    April 28, 2011 at 14:04 | Report abuse | Reply
  6. carashere

    I never realized how many people go directly to comments without even reading the article on which they're supposed to be commenting! Very enlightening for me, but I feel sorry for the two doctors who have offered their knowledge on men's prostate cancer treatment here.

    April 28, 2011 at 14:14 | Report abuse | Reply
    • Chartreux

      I read the article, Carashere. I always read the articles, unlike some people. Then I read the comments, all of them, which I agree went off-topic for prostate cancer.

      I respond to the comments. Some don't read all the article, they respond after reading part of it and they get it wrong. I've been reading these for some years and it's always annoying to see when someone didn't finish reading the article and spouts off something stupid when they misunderstood the reading. Happens all the time.

      April 29, 2011 at 09:12 | Report abuse |
    • Chartreux

      Why on earth do you feel sorry for the doctors?

      April 29, 2011 at 09:13 | Report abuse |
  7. Dinesh kapur Dr.

    If so much side effects, one must try other alternate therapy. Being consultant in acupuncture 'onnuri medicine' fully confident to alleviate the symptoms. smile, Enjoy!
    More on 'originsmile.wordpress.com'

    April 29, 2011 at 01:05 | Report abuse | Reply
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    January 25, 2012 at 22:09 | Report abuse | Reply
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