Editing Hormonal Therapy (section)

=== Hot flashes ===

* '''Lifestyle changes'''
** '''Avoidance of potential patient-identified triggers, commonly heat or spicy foods'''
* '''Pharmacological (5) (none are Health Canada-approved for hot flashes):'''
*# '''Medroxyprogesterone acetate (Provera)''' 20 mg orally daily
*# '''Megestrol acetate (Megace)''' 20 mg orally twice daily
*# '''Cyproterone acetate (Androcur)''' 50–100 mg orally daily
*# '''Gabapentin (Neurontin)''' 900 mg orally daily
*# '''Venlafaxine (Effexor)''' 75 mg orally daily
** Few case reports describe progression of prostate cancer with megestrol acetate; therefore, monitoring of disease is important
** The best pharmacological therapy to treat hot flashes remains unclear
*** '''Randomized trial comparing medical therapy for hot flashes'''
**** Population: 311 males with prostate cancer treated with ADT and experiencing hot flashes
**** Randomized to venlafaxine, medroxyprogesterone acetate, or cyproterone acetate
**** Primary outcome: change in median daily hot-flush score between randomization and 1 month
**** Results:
***** '''Decreases in hot-flush score were significantly larger in the cyproterone and medroxyprogesterone groups than in the venlafaxine group'''
**** Irani, Jacques, et al."Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial." The lancet oncology 11.2 (2010): 147-154.
* '''Intermittent ADT improves hot flashes and should be considered in appropriately selected patients'''
* '''Acupuncture may have a beneficial effect and can be considered in patients unwilling or unable to use pharmacotherapy.'''