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A summary of guidance by NICE for people who experience adverse effects due to hormonal treatment for prostate cancer
| Adverse Effect | Management Recommendations |
|---|---|
| Hot flushes | - Offer medroxyprogesterone (20 mg per day) initially for 10 weeks. Evaluate at the end. - Consider cyproterone acetate (50 mg twice a day for 4 weeks) if the above isn't effective. - Note that there's no evidence supporting complementary therapies. |
| Sexual dysfunction | - Inform about reduction in libido and loss of function before starting therapy. - Advise on loss of ejaculation and fertility and offer sperm storage. - Ensure access to specialist erectile dysfunction services. - Consider psychosexual counselling. - Offer PDE5 inhibitors for loss of erectile function. - If PDE5 inhibitors aren’t effective, offer intraurethral inserts, penile injections, penile prostheses, or vacuum devices. |
| Osteoporosis | - Do not routinely offer bisphosphonates to prevent osteoporosis. - Consider assessing fracture risk. - Offer bisphosphonates if they have osteoporosis. - Consider denosumab if bisphosphonates aren't suitable. |
| Gynaecomastia (Secondary care) | - Offer prophylactic radiotherapy to both breast buds within the first month for those starting long-term bicalutamide monotherapy. Use a single fraction of 8 Gy using orthovoltage, or electron beam radiotherapy. - If radiotherapy isn’t effective, consider weekly... |
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