DEAR DR. GOTT: Beginning in 2006 I received shots of Lupron Depot for a type of prostate cancer. My PSA has remained at 0.10. My general health has remained good except for annoying hot flashes at night that I’ve had for some time. My oncologist has offered no help or relief. Can you suggest anything?
DEAR READER: The treatment a man receives for prostate cancer depends on several factors, to include overall health, how fast the cancer is growing and whether or not it has spread. For example, men diagnosed early on may not require treatment to begin with, whereas those with progression of the disorder may elect to have hormone therapy, surgery or radiation.
Hormone therapy prevents the body from producing testosterone. The specific medications that stop this occurrence include leuprolide, triprotelin, histrelin and goserelin. There are other drugs such as the anti-androgens flutamide, bicalutamide and nilutamide that will block testosterone from reaching cancer cells. This type of therapy is used in men with an advanced case, as it slows the growth of the tumors and makes it more likely that possible subsequent radiation will be successful.
Surgery known as orchiectomy, removes the testicles and thus reduces the levels of testosterone from the body.
Radiation from either outside or within the body is still another option. External beam radiation directs very strong energy beams to the cancer site five days a week for several weeks. That placed within the body is known as brachytherapy and involves radioactive seeds placed into prostate tissue for an extended period of time. The implanted seeds will, over time, cease giving off radiation and will not require removal. Side effects of radiation can include erectile dysfunction, frequent/urgent/painful urination and loose stools that may be accompanied by pain.
Lupron Depot is a man-made hormone used to treat symptoms of advanced prostate cancer but can also be used for other medical conditions as determined by a physician This gonadotropin-releasing hormone agonist works by decreasing the levels of specific hormones that are produced by the testes and ovaries.
Side effects include nausea or vomiting, pain, swelling at the injection site, constipation, breast tenderness, fever, insomnia, and hot flashes. Depending on the advancement of your cancer, your physician might be able to convert you to another drug in the same class. I find it hard to understand why he will not address this concern, since hot flashes are well-documented. If he or she feels strongly enough that you should remain on the Lupron, perhaps another drug (such as female hormones, venlafaxine or gabapentin) to combat just that side effect can be prescribed for control. To ignore the issue isn’t appropriate. If absolutely nothing can be done, your physician owes it to you to explain why. He may be putting your overall well being at the top of his list and ignoring the “simple” concern that has overpowered your life.
Readers who would like related information can order my Health Report “The Prostate Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
