Medroxyprogesterone best for preventing hot flashes in ADT-treated prostate cancer

The hormonal treatments cyproterone acetate and medroxyprogesterone were both effective at reducing the severity of hot flashes experienced by men undergoing androgen deprivation therapy for prostate cancer. However, researchers said that because the use of cyproterone acetate may interfere with androgen deprivation therapy, medroxyprogesterone is the preferred treatment, according to the results of a randomized, placebo-controlled study.

All patients on trial (n=919) had been treated for six months with leuprorelin at one of 106 urology centers in France between April 2004 and April 2007. After six months, all patients who complained of frequent hot flashes (n=311) were randomly assigned venlafaxine 75 mg daily, medroxypregesterone acetate 20 mg daily or cyproterone acetate 100 mg daily. Assessment of hot flashes was done at inclusion, randomization, and weeks four, eight and 12. Patients were also asked to keep a hot flash diary for one week and to complete a quality-of-life questionnaire before each assessment.

All three medications effectively reduced the occurrence of hot flashes; however, cyproterone (94.5%) and medroxyprogesterone (83.7%) had larger reductions from baseline than venlafaxine (47.2%; P<.0001 for all).

Serious side-effects occurred in 16 patients — four, seven, and five cases in the venlafaxine, cyproterone and medroxyprogesterone groups, respectively. Only two cases were thought to be related to the drugs.

Irani J. Lancet Oncol. 2009; doi:10.1016/S1470-2045(09)70338-9.