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Prostate Cancer

Hot flushes, breast tenderness and breast enlargement

Many men who had had hormone treatment reported that they suffered from hot flushes. The National Institute for Health and Care Excellence (NICE) recommends medroxyprogesterone as the best treatment for hot flushes or if this is not effective cyproterone acetate or megestrol acetate. Some also said that they had experienced weight gain, breast enlargement, breast tenderness and mood changes. Many men found these symptoms uncomfortable and embarrassing. However, one man said that it was not always an unpleasant experience.

 

Describes the problems with hot flushes after hormone treatment.

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And you say you get these hot sweats during the day or at night?

Oh they're a real pain the hot sweats, I think I probably aggravate them because I do like hot tea, I like hot drinks and usually they come on soon after I've had a hot drink. But the annoying part is when they come on during the night because whereas I would normally have slept, I'm a great sleeper, I sleep very well, always have, obviously they wake you up and if they wake you up you go into the bathroom, but they are sticky and clammy and they last for about 5 minutes. Now a friend of mine who also has had this treatment he has been taking something called Red Berries which is a sort of herbal treatment and he says it certainly reduces, cancels out these hot flushes. I mentioned it to the specialist and he said well he couldn't see any reason I shouldn't take them if I wanted to. His view was he could give me tablets to reduce the hot flushes but they might have side-effects of upsetting the tummy so I rejected those. But the Red Berries may work but as my blood count has gone up this last year I thought well I'm not going to interfere with anything, I'll just leave it as it is. But no the hot flushes, I suppose I might get half a dozen during the day and a couple at night. Not, they're not serious they're just rather uncomfortable that's all. So they make you very, very wet and sticky for about 5 minutes and then they go off and no problem.

 

Describes the unpleasant symptoms of hot flushes.

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Age at interview: 61
Sex: Male
Age at diagnosis: 61
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The tablets and the injections. I chose that but it means that they've got to get rid of your male hormones and replace the male hormones with the female hormones and they'll tell you if they're worth their weight in gold these specialists they're going to give you the female menopause. And you actually go, you have the hot flushes and this is before the treatment. You have the hot flushes you wake up in the night you're a bath of sweat, your attitude changes, you get very nasty, very irritable, you get on a very short fuse, you'll take it out on the people you love and you'll rant and rave at them and you know you're doing it but unfortunately there's nothing at all that you can do about it, you just let it run its course, it's not very pleasant. Now I had, after the 4, 4 lots of injections.

 

States how embarrassed he is at the side effects of hormone treatment.

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Age at interview: 70
Sex: Male
Age at diagnosis: 66
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Does the Casodex affect you now?

Yes like all hormone therapy [laughs],it's hot flushes that if you're emotionally upset or anything like that, if you're embarrassed you just break out in a sweat and it can happen at any time, anywhere, it doesn't matter what the temperature you could be in the most, in a freezer and it can still happen. Any man who starts getting this, if he's got a wife who's gone through the menopause just ask her. My wife turns round and says 'You're not getting any sympathy off me', 'cos when you're in bed you see you break out in a sweat in bed and you want to throw the bed clothes off and that and I said 'Oh it's come again this hot sweats you know,' she says 'I know all about it, I've been through it,' she says 'You never got away from me when I was suffering,' and well we just laugh about it but it's uncomfortable and those are the only two things that, is lack of sleep, the insomnia and the hot sweats. But other than that I've never had any problems, I mean I'm just coming up to 71 and I've just got this new house, I've converted a building site to a garden and done a lot of hard work shifting furniture, decorating and all that so I'm not complaining you know, you've got to look at it positive.

 

Describes the varying side effects after different treatments such as breast tenderness.

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Age at interview: 65
Sex: Male
Age at diagnosis: 59
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Right, the Zoladex gives you hot flushes, exactly the same as women have when they're going through the change. Again, I didn't have them as bad as some men I've spoken to, some men have them really bad, they were sweating nearly the whole time and found it very, very uncomfortable. Waking up in the night absolutely bathed in sweat and having to get up and sometimes go for a cold shower to cool off. Fortunately mine were never that bad. Mine would last may be 3 or 4 minutes where I just absolutely boil up but you know and then I would just sit still and it would go off and I'd be okay again. But there was never any warning as to when that could happen but I found that triggers were often things like having hot drinks or being in a very warm room, things like that would bring the hot flushes on, that was the only problem that I had with Zoladex. When I started having the Stilboestrol, Stilboestrol stopped the hot flushes (laughs) so that was a benefit of having the Stilboestrol but the Stilboestrol caused breast swelling and breast pain, breast tenderness.

 

Comments that hot flushes can be a comfort on a cold day but could go as far as feeling faint.

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Age at interview: 66
Sex: Male
Age at diagnosis: 66
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And then later on the Zoladex implant, 10.8mgs of Goserelin, and there were side effects there that have grown stronger, the hot flushes for example. Actually these are mostly quite a pleasant experience on a cold day (laughs) to tell you the truth, but one experience where I was sitting at the back of church and listening to a lecture and got through 10 minutes of this very interesting lecture then I really felt like fainting which is unusual for me and so I missed a good 10 minutes of that and what was occupying my mind was who on earth is going to carry me. But that, that was the, I really felt very, very hot, very sweaty and very faint, almost like an attack of malaria, it was rather like that.

 
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Zoladex made David feel very tired. Casodex led to breast enlargement (gynecomastia) which was a...

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Age at interview: 61
Sex: Male
Age at diagnosis: 52
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But eventually about, this would be about five years after the initial diagnosis, I think, I was put back on eh hormone treatment, but I asked them about the options because I knew from experience that the Zoladex is quite difficult to live with, in some ways, in that it makes you quite tired, so it zaps your energy, and you’re also quite prone to hot flushes which are quite uncomfortable, as my wife knows very well, for other reasons. There was an alternative suggested to me and that was bicalutamide or Casodex, the brand name. I discussed this quite a bit with the registrar at the time, and I was told that the Casodex had the advantage of, perhaps not making me feel so tired, and not giving me the hot flushes in the way that the Zoladex would, but there was a disadvantage that I was quite likely to have gynecomastia, my breasts would grow quite big, and I asked him at that stage, you know, “how big”, and he indicated to me that well it wouldn’t it wouldn’t be too bad, so I was on Casodex for about, about two years, two, I mean I can check all these dates, but I think it was about two years, but during that time my breasts actually did get very big, and to the point where it was really a problem. Now I should say it was offered to me at the time I went on Casodex that I could have had radiotherapy treatment to prevent this happening but on discussing it I opted not to do that, because it was an intervention that I thought, “well this isn’t going to be a life threatening condition so why bother to have some other treatment which is an intervention of a kind”, so I opted not to have it, but of course by the time your breasts grow bigger, it’s too late and you can’t have that treatment, it’s no longer an option. I discussed this with various people and tried different ways of disguising it physically, but in the end I opted to go and have a breast reduction done, I actually thought I was going to have a breast removal done, but I’d been recommended by, yet another consultant, oncology consultant, that the best way of approaching this would be to go and see a plastic surgeon and have it, you know, have the treatment done that way, have the surgery done that way. I did that, I had to pay for it privately, and I actually had to pay in cash although I have medical insurance, they wouldn’t support that, wouldn’t pay for it, even with a, you know we had a long argument about this, even though they will pay for breast reconstruction for women, and this is a very similar situation, they wouldn’t pay for, for this treatment for me, so I paid for that, had it done, just in time for my daughter’s wedding, which was quite good, it made me feel a lot better about standing up in front of people. But to my dismay I found that my breasts grew again quite quickly afterwards, however, at that time, it was also obvious that the Casodex treatment wasn’t working because my PSA score was going up, so I’ve been back on Zoladex now for about four months, and finding things quite hard to be honest (laughs) simply because it makes me very tired, I’ve really got very little energy, and I’ve put on a lot of weight, it’s all in a sort of vicious circle, lack of energy, and the lack of exercise that comes from that then means that my weight has gone up quite a bit, and that makes it worse, so it’s quite hard at the moment, but that’s really where I’ve got to now, that I’m back on Zoladex.

So the breast reduction helped but I really should have gone for a mastectomy, but I needed it done before a wedding came up, and there wasn’t an option to have it done that quickly on the health service, I’d probably still be waiting on it in the health service.

 

Men who have had both testicles removed or are taking hormone therapy for prostate cancer are at risk of bone thinning (osteoporosis) due to the reduction of testosterone. A DEXA scan can be used to measure bone mineral density and see if bones have become weaker. Weaker bones can lead to an increase risk of bone fractures.

To protect bones a doctor may advise; calcium and vitamin D supplements, to stop smoking, reduce alcohol intake, and take regular weight bearing exercise such as; walking, light weight lifting or dancing.

If men having hormone therapy are diagnosed with osteoporosis they may be offered bisphosphonates or denosumab as a treatment to reduce bone thinning.

Last reviewed July 2017.

Last updated March 2015.

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