Dear Dr. Roach: I am 67 years old and have a lot of medical issues, including diabetes, high blood pressure, a previous heart attack, a small stroke, and a stent in one of the major arteries to my brain. I was recently diagnosed with prostate cancer, as my PSA level was elevated.
I underwent radiation for my prostate, and I am now on hormone shots. I have terrible hot flashes. I noticed on television there are medications that don’t come from hormones for women who have hot flashes. Is there a treatment available for men?
W.M.
Most women will have symptomatic hot flashes that come about the time that menstruation stops; these are caused by the loss of hormones. Men can get similar symptoms, but only when the male hormones are stopped suddenly and completely, which is typically part of treating a hormone-dependent malignancy, especially prostate cancer. GnRH analogues like leuprorelin are the most common.
Just as in women, the most effective treatments are hormones, but they have significant side effects in men. Estrogen treatments promote breast growth, while megestrol — a progesterone — promotes weight gain. Megestrol may also promote the growth of prostate cancer. For these reasons, many experts first prescribe nonhormonal agents such as venlafaxine, which reduces hot flash by about 50%. Gabapentin is equally effective, but neither are as effective as hormonal treatments, such as estrogen gel. A small study on acupuncture to the earlobe found effectiveness.
I have mentioned the new treatment for symptomatic menopausal women, called fezolinetant. I could not find data in men, but found a trial noting that some effective treatments for women are not effective for men. More studies are needed.
Dear Dr. Roach: My wife passed away from cancer, but also had what the doctors thought was Lewy body dementia. I hear of many studies that say new treatments for Alzheimer’s may show some progress. My question is, are all forms of dementia basically the same? If they find a cure for Alzheimer’s, would it not be a cure for other forms of dementia?
L.D.
I am sorry to hear about your wife. Although there is some promising research about different types of dementia, Alzheimer’s is very different from Lewy body dementia or other less-common forms of dementia. This includes dementia that is due to multiple strokes; frontotemporal dementia; and other diseases that are sometimes associated with dementia, like Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. It isn’t likely that an effective treatment for one will work for the others, since each of them causes dementia in a different way.
As we await effective treatments, I am asked every week about supplements advertised as treatment or cures for dementia. None of these have been proven to work, and marketing that says otherwise is, at best, misleading and, at worst, a deliberate lie. Save your money and concentrate on a healthy diet, regular exercise, and keeping your mind active.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
