Managing hot flushes in men after prostate cancer--a systematic review.
OBJECTIVE
The aim of this study was to describe hot flushes in men with prostate cancer, and their treatment methods.


METHODS
A systematic review was conducted of the literature indexed between 1966 and 2009 on the MEDLINE, the ISI Web of Knowledge, Cinahl and PsycINFO. Of 252 articles identified, 32 were selected for consideration of their complete texts, of which five were subject to detailed analysis.


RESULTS
Diethylstilbestrol, megestrol acetate and cyproterone acetate have the strongest effect, giving a 75% or larger decrease of the number of hot flushes, but they may have severe or bothersome side-effects. Gabapentin has an uncertain effect. Clonidine is not proven effective for hot flushes. Long-term effects were not evaluated in any of the studies. SSRI/SNRI and acupuncture may have a moderate effect on hot flushes but are not proven in any RCTs.


CONCLUSIONS
Hot flushes are common and bothersome symptoms in men with prostate cancer and those taking anti-androgen treatment, and reduce quality of life. Few treatments are available and some are avoided for these patients. Additional prospective treatment studies are needed, with long-term follow-up, in order to evaluate the effects and risks of treatments. Treatments with few or no severe side-effects should be prioritised in future investigations. Experimental studies are also needed to elucidate the mechanism behind hot flushes in men and to suggest routes for the development of new treatments.
Frisk
Jessica
J
Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden. jessica.frisk@liu.se <jessica.frisk@liu.se>
D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D005483:Flushing / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000726:Androgen Antagonists; D004968:Estrogens, Non-Steroidal; D007987:Gonadotropin-Releasing Hormone