Medroxyprogesterone best for hot flushes in prostate cancer

Medroxyprogesterone should become the standard treatment for preventing hot flushes in men receiving hormone therapy for prostate cancer, researchers suggest. Hot flushes are a common side effect in men undergoing hormone therapy, however direct comparisons have not been made to establish clear recommendations between treatments, the researchers wrote in The Lancet Oncology. More than 900 men with prostate cancer were initially treated with the gonadotrophin-releasing hormone (GnRH) analogue leuprorelin. After 6 months, patients who had 14 or more hot flushes in the week before assessment or those who spontaneously requested treatment were randomly assigned to further treatment with either venlafaxine (n = 102), medroxyprogesterone (n = 108), or cyproterone acetate (n = 101). Overall, all treatments were effective in reducing hot flushes; however cyproterone acetate and medroxyprogesterone were significantly more effective than venlafaxine. At four weeks after treatment, median daily hot-flush scores improved by more than 47% in men receiving venlafaxine, nearly 95% for those on cyproterone and almost 84% for medroxyprogesterone. The association was similar at four, eight and 12 weeks after treatment. The researchers noted that while cyproterone is a recognised treatment in prostate cancer, it could interfere with hormonal therapy. “We therefore consider that medroxyprogesterone should be considered the standard treatment for hot flushes in men undergoing androgen suppression for prostate cancer,” they concluded. They added that their study also highlighted that a significant number of patients with hot flushes do not seek treatment, as only 22% of those enrolled requested further treatment. “In our view, this justifies the recommendation not to systematically prevent hot flushes in all patients on initiation of an androgen-suppressing treatment.”

December 11, 2009  Tags: , , , , , , , ,   Posted in: Prostate Cancer Treatment

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