As a wealth management consultant for a prestigious London firm, Craig Lister is used to keeping his cool. But lately, that's become rather more difficult. Craig, 54, is on hormone therapy for prostate cancer, which starves cancer cells by reducing levels of testosterone in the body - and has the side-effect of hot flushes. 'I have about ten to 12 flushes a day, and six to eight at night,' says Craig, a Yorkshireman who lives in Watford, Hertfordshire, with wife Sue, a teacher, 52, and their three children, George, 22, Evie, 20, and Joseph, 18. Craig, 54, was diagnosed with prostate cancer in 2012. He is now well and his tumours have shrunk . 'I know when one's coming. The feeling suddenly builds up as if you've gone into a sauna. Within minutes I'm in full sweat. Five or ten minutes later, it's gone.' Craig has taken to carrying a spare shirt in his briefcase when he goes to meet clients. 'I'll turn up to a lunch and suddenly have a hot sweat and my shirt will be soaked,' he says. 'I nip off to the loos and have a wash and change.' Hormone therapy, usually given in the form of regular injections or implants, is the first treatment offered to men with advanced prostate cancer - where the cancer has spread beyond the prostate. It can't cure the cancer, but can help keep it under control. Hormone therapy is also given alongside radiotherapy to some men with localised prostate cancer to shrink the cancer and make it easier to treat. The jabs typically contain drugs called luteinizing hormone-releasing hormone (LHRH) blockers. These act on the pituitary gland in the brain, to stop the production of hormones which are released into the bloodstream and bind with cells in the testicles to make testosterone. Even though the cancer is now microscopic he is still taking hormone treatment . The majority of prostate cancers rely on the hormone to grow. Lowering the amount in the body means it's less able to spread. In England alone, 13,000 men receive the treatment every year - in the form of jabs given monthly or every three months according to the charity Prostate Cancer UK. However, blocking testosterone can cause a variety of side-effects, explains Ali Rooke, a specialist nurse at the charity. 'Testosterone is a man's natural source of energy, so along with hot flushes we often see fatigue. It also has an important role in sexual function, so there can be a loss of libido,' she says. 'There can be mood swings and depression; some men also report breast swelling, nipple tenderness and weight gain around the middle. All of these are similar to what women go through during the menopause, when levels of their equivalent hormone, oestrogen, start to fall.' Hormone therapy also raises the risk of cardiovascular disease and type 2 diabetes, and can cause bone thinning, because testosterone is important for bone density. Studies by Prostate Cancer UK have found that 80 per cent of men having hormone therapy will suffer hot flushes, and 27 per cent of these say it is the side-effect that troubles them the most. This rings true for Craig. 'People don't tell you much about hormone therapy at the beginning,' he says. 'I am basically a menopausal man. I have mood swings and I've put on two-and-a-half stone. But the worst thing has been the hot sweats. I'm up a few times a night, sometimes having to change the sheets and it's tiring. 'Of course, this wakes Sue up, too, and then she's worrying. 'She used to have hot flushes and so she's very sympathetic. The difference with me is that I don't know if they will ever end.' Men with advanced prostate cancer could be on hormone therapy for the rest of their life, says Ali Rooke. 'But men who are on it along with radiotherapy tend to only have it for up to three years until the cancer has been treated.' She says the charity receives hundreds of calls every year from men struggling with hot flushes and side-effects of hormone therapy. 'Men are warned about side-effects, but clinic appointment times are not long, so doctors can't realistically talk through them all in detail. It's also hard to predict what side-effects a man will have and how he will respond.' There are treatments to alleviate hot flushes, such as drugs based on the female hormone progesterone, which has an effect like testosterone but doesn't fuel the growth of cancer cells. Some men find that complementary therapies, such as acupuncture, or herbal supplements, such as sage tea or black cohosh, help, but the benefits are yet to be proven clinically. But now new research suggests that cognitive behavioural therapy, or CBT, a psychological technique and talking therapy, could help. This causes hot flushes and night sweats . A trial on prostate cancer patients at King's College London, published in March, has shown such impressive results that it is likely to be offered nationally. CBT works by helping people understand the links between their beliefs, thoughts and behaviour. It's a recognised treatment for anxiety and other mental health conditions. Myra Hunter, professor of clinical health psychology at King's, has previously found that CBT reduces hot flushes in menopausal women, and breast cancer patients who are experiencing them as a result of treatments that reduce levels of oestrogen. 'Beliefs about hot flushes can exacerbate the symptoms,' she says. Professor Hunter believes that by replacing overly negative thoughts about hot flushes with more helpful, positive ones, they will have less of an impact. Her latest study recruited 68 men receiving hormone therapy for prostate cancer, all of whom were experiencing at least ten hot flushes and night sweats a week. Half the group were given treatment as usual (access to doctors and information about the problem) and the other half received a self-help CBT booklet, a CD and two sessions with a psychologist. The men were taught breathing exercises, advised on lifestyle changes and sleep management, and encouraged to challenge negative beliefs and presumptions. 'Women feel hot flushes are a signifier of their age and reproductive status,' says Professor Hunter. 'In our interviews with men, we found the hot flushes signified a threat to their masculinity. 'They felt the hot flushes had social consequences - people would think that there was something wrong with them. And they catastrophised, so if they had one in the night they assumed they'd feel terrible the next day.' After six weeks, the CBT group's hot flushes were 40 per cent less problematic and 36 per cent less frequent, compared with 12 per cent and 16 per cent reductions in the control group. CBT is not always easily available on the NHS. Professor Hunter is hoping to offer her self-help audio guide and booklet for hot flushes free through Prostate Cancer UK, but this has not yet been confirmed. Craig was diagnosed with advanced prostate cancer three years ago, at the age of 50, so quality of life is important to him. By the time of his diagnosis, the cancer had spread beyond the prostate to his lungs and to the lymph nodes in his pelvis and abdomen, so surgery was not an option. While the hormone treatment has been helpful, the hot flushes have been hard to deal with. He is about to try a new type of radiotherapy, but expects to be on hormone therapy indefinitely. However, he says taking the right attitude to hot flushes has helped him hugely. 'From the beginning I've been open about my condition, so all my friends and clients know why I have hot flushes. 'It's nothing to be embarrassed about. My family and I have learned to live in the now and be grateful for what we've got.' prostatecanceruk.org .
Craig Lister, 54, from Watford,  is on hormone therapy for prostate cancer . This starves cancer cells by reducing levels of testosterone in the body . One side-effect is hot flushes: 'I have about ten to 12 flushes a day'