Systematic review of pharmacological and non-pharmacological interventions for hot flashes in men with prostate cancer undergoing androgen deprivation therapy (ADT), based on 35 studies identified from a PubMed search of 469 papers.
Across all blinded pharmacological trials, hot flash frequency fell by 21%–84% (placebo effect: 19%–30%). Hormonal agents (cyproterone acetate, estrogen/derivatives) showed the greatest efficacy; acupuncture and CBT offered modest benefit; dietary supplements (Dong Quai, soy protein, Salvia officinalis, Serelys Homme) appeared ineffective.
- Only 35 of 469 papers were included, and the overall evidence base is limited in size and quality. - The review does not include newer agents like fezolinetant, which have not yet been evaluated in this population. - Study heterogeneity in outcomes (frequency vs. quality of life) limits direct comparisons across interventions.
For men on ADT troubled by hot flashes, hormonal agents (cyproterone acetate or estrogen) are the most effective options but carry side effect risks — discuss these trade-offs with patients. Acupuncture or CBT are reasonable non-hormonal alternatives; routine use of dietary supplements is not supported.
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