ReviewGynecomastia in patients with prostate cancer: a review of treatment options
Section snippets
Diagnosis of gynecomastia
In the early stages of gynecomastia, there is a proliferation of the glandular ducts, epithelial hyperplasia, expansion of stroma, increased vascularity, and periductal edema. However, when gynecomastia has been present for a substantial time, at least 1 year, a reduction in epithelial proliferation is seen, and hyalinization and fibrosis of the stroma occur—processes that are usually irreversible.
Although gynecomastia is common there is no consensus on which methods to use for defining and
Prostate cancer treatments associated with gynecomastia
The premise underlying endocrine therapy for prostate cancer is that testosterone stimulates the growth of the cancerous tissue. Therefore, the aim of treating prostate cancer patients with hormone manipulation is to eliminate circulating androgens, and/or to block their effects on cancer tissue. However, changes in the hormonal milieu induced by such manipulation can alter the ratio of circulating estrogens to androgens, and thereby increase the likelihood of developing gynecomastia. The
Treatment of gynecomastia
Three forms of treatment have been used effectively to alleviate or prevent the development of gynecomastia and/or breast pain: radiation, surgery, and medical therapy.
Dr. Peter Iversen
I am increasingly using nonsteroidal antiandrogen monotherapy (bicalutamide 150 mg/day) in the treatment of prostate cancer in my clinic. Patients are routinely offered prophylactic irradiation of the breast, with a single 8-Gy dose. Adverse events are typically minimal, with only a temporary slight skin discoloration. In the absence of randomized data, it is my clinical impression that this regimen almost completely alleviates breast tenderness, and minimizes gynecomastia. However, some
Comment
Although gynecomastia is a common side effect of treatment for prostate cancer, especially following estrogen or antiandrogen monotherapy, it is not well documented. Before initiation of hormonal therapy for any stage of prostate cancer, an examination of the breasts should be performed and any enlargement documented: the patient may have pre-existing gynecomastia due to another factor such as aging or excessive alcohol intake. In addition, the possible breast changes that may occur with
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Chronic cancer pain syndromes and their treatment
2022, Neurological Complications of Systemic Cancer and Antineoplastic TherapyActivation of PSGR with β-ionone suppresses prostate cancer progression by blocking androgen receptor nuclear translocation
2019, Cancer LettersCitation Excerpt :Targeting androgens with androgen deprivation therapy (ADT) is a standard treatment for advanced PCa that can successfully prolong survival rates [4]. However, several side effects, including decreased libido and fertility, osteoporosis and metabolic disorders, can be induced by ADT and remain a concern for many patients [5–9]. Furthermore, most patients fail to respond to ADT after an average of 12–18 months, and their tumors progress into the castration-resistant stage [10–12].
Treatment of gynecomastia in patients with prostate cancer and androgen deprivation
2014, Actas Urologicas EspanolasIs prophylactic breast radiotherapy necessary in all patients with prostate cancer and gynecomastia and/or breast pain?
2010, Journal of UrologyCitation Excerpt :Breast tenderness and/or pain, psychological discomfort and/or possible embarrassment due to 150 mg bicalutamide therapy may cause treatment discontinuation.14,15 Thus, treatment strategies for gynecomastia and breast pain induced by antiandrogens are still a major point of investigation.2,10–13,16 RT is accepted as a reasonably effective method to prevent hormone induced gynecomastia.10–13,16,17
Complications of hormonal treatment for prostate cancer
2009, Complications of Urologic Surgery: Expert Consult
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D.G. McLeod is a study investigator for AstraZeneca, Macclesfield, Cheshire, U.K. P. Iversen is a study investigator funded by AstraZeneca.