NHS - Lincoln & Louth County Hospitals, UK 
Private - BMI The Lincoln Hospital
 
Mr.H.VARADARAJ
Consultant Urological Surgeon
   Home      Patients Questions Answered ~ Bladder, Prostate Cancer      Prostate Cancer
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PROSTATE CANCER RELATED PATIENT QUESTIONS
 
1) I started the 3 monthly hormone injection Zoladex for my prostate cancer 4 months ago  and I have excessive sweating and my clothes are drenched at night. I get hot flashes during the day with intermittent sweating and this is bothering me.  Is there any treatment to stop this?
 
Mr.Varadaraj -  Zoladex is a luteinizing hormone releasing hormone (LHRH) agonist which acts on your pitutory gland and stops the production of testosterone from your testicles. The drop in testosterone will slow or stop the growth of prostate cancer. LHRH agonists have the side effect of bringing on episodic hotflashes and sweating. This can be controlled with a tablet called cypreterone acetate (Andocur). Please contact your General Practitioner, discuss the problem and then your GP can prescribe cypreterone acetate after looking at your medical history to outrule any contraindications to this medication.
 
Diethy-stilbesterol (DES) 0.5 mg/day or medroxyprogesterone acetate are alternatives to cypreterone acetate that reduce the frequency and severity of hot flashes.
 
2) My Father 84 years old, was diagnosed with prostate cancer 3 years ago with spread to bones and his PSA was 580ng/ml then. He responded to 3 monthly harmone injection for about 16 months and was changed to second line treatment with stilbesterol 1mg around 8 months ago. He was seen in the urology clinic 3 months ago and told his PSA  was 28ng/ml  which is  rising again slowly. In the last 8 weeks he has been having bony pain in his hips and back and is on oral morphine for pain control. He has a date for  bone scan and review in  the  NHS clinic with his urologist for this new problem in 3 weeks from now. However his left hip pain has become severe in the last 10 days with difficulty to take even a few steps. Will he need morphine injection pump to control his pain or any alternative treatment?
 
Mr.Varadaraj - Based on the details you have provided there is a possibility that he has metastatic spread to the upper part of his left femur (hip bone). When the prostate cancer metastases in a bone grows, it gives rise to severe pain and at times causes the bone to break or fracture, referred to as pathological fracture. Such pathological fractures happen when metastatic cancer involves the  hip joint area of femur (upper part of thigh bone), the spine bone (vertebra) or the long bones in the limbs. Significant destruction in the case of spine bone by the cancer without or with pathological fracture can lead to weakness or paralysis of the legs and needs to be treated at the earliest or as an emergency. When prostate cancer advances and becomes androgen-independant prostate cancer  PSA cannot be relied on as the cancer can be an agressive form which is not secreting PSA. In such cases PSA may not rise significantly even though the cancer is growing and spreading.
 
When patients with metastatic prostate cancer have severe bony pain a plain bone xray of the area of pain with bone scan or MRI scan will confirm a spread and growth of cancer in the area of bony pain. A single dose of  high intensity xrays or Radiotherapy for bone metastases is then given to this localised area of significant  spread in the bone which can bring about a relief of the severe localised bony pain. The need for this  radiotherapy for pain will be decided by the radiation oncologist along with the urologist. 
 
There is a medicine (Bisphosphonates) available that is given through the vein for 15 minutes once every 3 to 4 weeks, which acts to stabilise the bones, reduce bone loss, bone pain when the prostate cancer has spread to the bones and the patient has bony pain due to this spread. The bisphonates (Zometa - Zoledronic acid) can delay the development of bony problems or complications by upto 6 months, strengthen the bones and can be given if the kidneys are functioning normally.
 
As he is a patient outside our ULH trust hospitals,  I am not sure if he has a urology specialist nurse/ key worker looking after him who can be contacted for urgent discussion regarding his current problem, which may need immediate attention as a possibility of  hip pathological fracture needs to be ruled out. Alternatively contact his  GP who might be able to arrange an urgent admission to the hospital after reviewing  his details.  
 
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