How do you manage hot flashes in men with prostate cancer on androgen deprivation therapy?  

I prescribe Effexor extended release (XR) 37.5 mg increasing to 75 mg if needed. Serves double duty since many men would benefit from an antidepressant anyway. Works for women as well.

Pilot studies for the antidepressants venlafaxine and paroxetine suggested they may be useful for men having hot flashes in androgen deprived states (Loprinzi et al., PMID 15473404 and Quella et al., PMID 10379749). One placebo controlled trial evaluating venlafaxine and a soy protein showed more su...

I typically use Effexor xr 37.5 mg daily too. Most men have a good response with a rare intolerance to the medication.

I have used Depo-Provera 400 mg i.m., with one injection having a very high rate of response in totally eliminating hot flashes. I prefer using this therapy in those men with excellent control of the prostate cancer, i.e. those with undetectable PSA levels in the < 0.05 ng/ml range, since progest...

Over the years for my prostate cancer patient experiencing hot flashes and related symptoms from ADT usage, my first option for the patient is to suggest either daily bee pollen or honey. It has been a rare occasion where I have had to resort to stronger medications. And, though this Germa...

Data investigating therapies to specifically mitigate ADT induced hot flashes is not robust and mainly extrapolated from post-menopausal women and women receiving therapy for breast cancer.As @Stanley Liauw mentioned, the use of Megestrol is supported by a double-blind placebo controlled trial....

After receiving a number of pharmacy responses about the risks of prescribing Megace, I have been using Gabapentin 300 mg Qhs with good results and few side effects.

I have recently had success with oxybutynin 5 mg BID and have moved from venlafaxine and megestrol acetate to this as my preferred agent. See https://ascopost.com/issues/july-10-2018/oxybutynin-in-prostate-cancer/ which discusses this case report. 

I start with a combination of vitamin E and selenium, because it's easy enough and why not try it? There's a percentage of patients who definitely respond to this. If that doesn't work, I'd prefer not to start another steroidal-based medication and I have had some patients have sleep disturbances an...

Effexor. Reasonable efficacy and treats mood. Oh, and eliminate the low-hanging fruit. Caffeine, alcohol, tobacco, tight-fitting clothes, lack of circulating air.

I use low-dose Megestrol (generally 20 mg/day, sometimes 40 mg/d) based on Loprinzi et al., PMID 8028614. This works for most of my patients. 

I use venlafaxine starting at 37.5 mg per day. I would be leery of using megestrol given the risk of blood clots/MI. It might be rare, but it doesn't seem worth it since there's a good alternative.

Effexor XR, 37.5 mg nearly always does the trick. And, as ADT causes mood changes, it takes care of that too.

Megace 20 mg/d has been helpful for some of my patients with severe hot flashes. This is supported by a SWOG randomized trial to reduce hot flashes in women treated for breast cancer (at 3 months, 65% of women had a 75+% reduction in hot flashes, compared to only 14% who had placebo).

I have given Depo Provera 150 mg IM for numerous prostate patients with excellent results. I have not had any feedback of negative side effects. It is usually good for about 3 months.

I have been very disappointed with venlafaxine. Many of the side effects of ADT are associated with the concurrent reduction in E2. High-dose transcutaneous estrogen patches have been shown to be effective (and safe) at reducing testosterone to castrate levels (See- the results of the cleverly nam...