October 11, 2004 -- An antidepressant medication is an effective treatment to reduce hot flashes in men who are taking hormone therapy for prostate cancer, Mayo Clinic researchers report in the October issue of Mayo Clinic Proceedings.
The five-week study followed 18 men who completed the therapy, illustrating that their hot flashes decreased from 6.2 per day to 2.5 per day. Hot flash scores, the frequency multiplied by the severity, decreased in the same period from 10.6 per day to 3 per day.
"Newer antidepressants have been proven effective in reducing hot flashes in women but have not been studied in men," says Charles Loprinzi, M.D., Mayo Clinic Division of Medical Oncology and the lead author of the study. "Although hot flashes in men with prostate cancer are well documented," he said, "their treatment has not received as much attention."
Some doctors treat hot flashes in men receiving hormonal therapy with a short course of a secondary hormone such as Megestrol acetate. But the Mayo team now expresses some "concern" about these secondary treatments (see below).
The study looked at men receiving androgen ablation therapy, also known as hormonal deprivation therapy, or hormonal blockade, which is a well-established treatment for various stages of prostate cancer. The antidepressant tested, paroxetine (Paxil), has been used to treat mental depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder and social anxiety disorder, among others. A placebo-controlled trial had previously demonstrated that paroxetine reduced hot flashes in women.
The study was conducted between August 2001 and October 2003. Men eligible for the study had to have a history of prostate cancer for which they were receiving androgen ablation therapy.
Previous Mayo studies suggested that venlafaxine (Effexor) is effective to treat hot flashes in men undergoing hormonal therapy and that citalopram (Celexa) reduces such hot flashes in women.
A commoner, older treatment for hot flashes is Megace (Megestrol acetate). Megace is a progestogen, a man-made form of the female hormone progesterone. Megace is sometimes used to treat prostate cancer and when given with newer hormone blockade drugs like Lupron or Zoladex it reduces hot flashes by up to 90 per cent, according to a Mayo study in 2002.
But there have been reports of men whose prostate cancer progressed while taking Megace, In 1999 Oliver Sartor M.D. at Louisiana State University Medical Center, reported "a case in which megestrol acetate (20 mg bid) was administered for symptomatic control of hot flashes in a medically castrated patient with prostate cancer. The patient was subsequently noted to have a rising prostate-specific antigen (PSA) level. Megestrol acetate administration was discontinued, and the PSA level declined. These data indicate that even the low doses of megestrol acetate used for control of hot flashes can be associated with PSA increases in some patients with prostate cancer."
This may be especially a concern because, as another study points out, patients whose doctors prescribed Megace for hot flashes have been found to stay on this treatment for three years or more. The authors of the current Mayo study say this therapy "may affect prostate cancer growth and/or cause significant side effects."
Patients who do not wish to take an antidepressant for hot flashes need not feel like mavericks. Most patients who experience hot flashes are not interested in adding a medication to suppress them. In a presentation at ASCO in 2001, a team from University of Pennsylvania Cancer Center said that although over 70 per cent of prostate cancer patients they studied complained of "a little" to "some" discomfort during hot flashes, "of those not receiving treatment, fewer than 50 per cent would consider taking medication to treat them." Hot flashes are "a significant side-effect of hormonal treatment," this team concluded, and drugs are available to manage the flashes, but "a significant percentage of patients do not find it as an acceptable option. Therefore, alternative support/educational interventions should also be considered to help patients better understand manage and cope with this treatment side effect. "
Working with Dr. Loprinzi on the Paxil study were: Debra Barton, R.N., Ph.D.; Lisa Carpenter; Jeff Sloan, Ph.D.; Paul Novotny; Matthew Gettman, M.D.; and Bradley Christensen, all from Mayo Clinic.
Mayo Clinic Proceedings, a peer-review journal, is published monthly by the Mayo Foundation. See
http://www.mayo.edu/proceedings/2004/oct/oct2004.html
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Edited by J. Strax, Oct 11, 2004
