How to treat hot flashes and sweating during endocrine therapy for prostate cancer?

Most patients with advanced metastatic prostate cancer generally receive endocrine drug treatment. Compared with surgical treatment and chemotherapy, endocrine therapy has obvious advantages in terms of safety and adverse reactions. However, in clinical work, some patients receiving endocrine therapy do have repeated and obvious symptoms of hot flashes and sweating.

Although these symptoms will not lead to serious adverse consequences, repeated attacks will significantly affect the patient's quality of life. Moreover, there is currently no unified and effective treatment for hot flashes and sweating symptoms in clinical practice, which brings troubles to many patients who must regularly use endocrine drugs. What exactly causes these symptoms and how to deal with them?

Hot flashes that occur after endocrine therapy generally have the following characteristics: the patient first feels an increase in temperature on the face and trunk, accompanied by dilation and flushing of the skin blood vessels on the face, neck, and limbs, which is usually followed by obvious sweating.

The reason for this is that after using anti-androgen secretion drugs, the levels of luteinizing hormone and follicle-stimulating hormone in the patient's body are significantly reduced, which reflexively leads to the release of catecholamine hormones in the hypothalamus, especially norepinephrine. These increased hormones act like tides on the body temperature regulation center in the anterior hypothalamus, leading to abnormal peripheral vasodilation and poor regulation of the body, and then repeated hot flashes and sweating. For most patients, the symptoms of hot flashes and sweating will gradually decrease or disappear after they begin regular endocrine drug treatment. For those whose symptoms persist or significantly affect the quality of life, targeted drug treatment is recommended.

Currently, the effective drugs reported include estrogen, progesterone, clonidine, gabapentin, and selective serotonin reuptake inhibitors, etc. Because these drugs also involve effects or reactions on other systems in clinical applications, it is recommended that patients should choose to use them under the guidance of a physician during outpatient follow-up visits.