Hot flashes have not subsided post-prostate cancer treatment
DEAR DR. ROACH: I'm a 76-year-old man who was treated for prostate cancer starting in summer 2017. Following radiation therapy, I was given Lupron injections every six months for two years. It's been two years since my last injection, but I still experience hot flashes as a result. Will these hot flashes stay with me for the rest of my life? My urologist assured me that the hot flashes would subside approximately a year after the final shot. -- D.T.
ANSWER: Leuprolide (Lupron) is a medicine that prevents the body from making testosterone. Back in 1941, depleting testosterone was proven to slow prostate cancer growth, but even in the first group of subjects, there were men with severe hot flashes. The sudden drop in testosterone causes "vasomotor instability," meaning that the blood vessels in the skin suddenly dilate, causing an intense heat sensation. The whole body can cool down with this, leading sufferers to feel cold afterward.
I can't predict how long these symptoms will last, but it does not shock me that they have continued for two years. Given that they seem to be quite bothersome, you should ask your urologist or oncologist about treatment. Just as with menopausal women who have hot flashes, there are treatments that can reduce, though perhaps not eliminate, the number of hot flashes you get per day.
There are hormonal and nonhormonal treatments. With hormonal therapy (such as a progestin), there is the possibility of stimulating prostate cancer growth, so most experts prefer trying nonhormonal treatments first. Both antidepressants and antiseizure medicines have been found to work, even though hot flashes are not related to depression or seizures.
DEAR DR. ROACH: I just got my COVID-19 vaccination with the Moderna vaccine. I will have a booster in 28 days. Am I protected from the "new strain"? Or will I need yet another type of vaccination? -- J.P.
ANSWER: At the time of this writing, most experts agree that both the Pfizer and Moderna vaccines provide a high degree of protection against the currently predominant strains. There is less protection against the South African variant.
Some variants, such as the UK B.1.1.7, seem to be more likely to transmit from person to person compared with those that have previously been circulating, and may even be more likely to cause serious disease or death in an infected person.
Despite the reassurance about protection, it is possible that future mutations in the virus could lead to a large enough structural change in the spike protein that the vaccine will be significantly less effective.
The best way to prevent this is to get control over the pandemic as fast as possible. The more people that are infected with COVID-19, the more chances the virus has of developing a resistant variant. If that happens, a new vaccine would indeed be needed, although vaccine development would be much easier due to the immense amount of work already done.
It is not clear whether yearly (or some other frequency) boosters will be required. Immunity might wear off, or new variants may continue to emerge that require new vaccines. This is similar to what is seen with seasonal flu. This is all speculative until we have more information.
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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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