A Review of Hot Flash Management in Patients with Prostate Cancer.

Context: Vasomotor symptoms (VMS) including hot flashes are a common toxicity reported by men undergoing androgen deprivation therapy (ADT) and their effective mitigation remains crucial in prostate cancer survivorship. As the understanding of hot flash pathophysiology is refined, novel therapies offer promising benefits to this patient cohort.

Evidence acquisition: The following mini-review outlines the landscape of VMS management in patients with prostate cancer as informed by a literature search using the PubMed and Embase databases.

Evidence synthesis: Hormonal therapies appear most effective for ameliorating VMS in men with prostate cancer experiencing bothersome hot flashes. Transdermal oestradiol has been well-validated, with recent evidence hinting at its promise as an alternative form of ADT that mitigates VMS. Nonhormonal treatments proven to be efficacious include gabapentin, oxybutynin and various antidepressants although their utility can be limited by adverse effects. There is significant interest in novel agents like fezolinetant that target hypothalamic thermoregulatory pathways, however further validation in this cohort is required. Nonpharmacological options including cognitive behaviour therapy and acupuncture may also have a role although further research is needed to clarify the optimal schedule and confirm superiority over placebo.

Conclusion: Clinicians should be prepared to offer evidence-based management options for the detrimental effects of ADT. Proven therapies for VMS including oxybutynin and antidepressants may soon be complemented by neurokinin antagonists which currently boast great efficacy for menopausal hot flashes. Hormonal options like transdermal oestrogen are most likely to provide relief but gynaecomastia may develop.