Elsevier

Urology

Volume 56, Issue 5, November 2000, Pages 713-720
Urology

Review
Gynecomastia in patients with prostate cancer: a review of treatment options

https://doi.org/10.1016/S0090-4295(00)00823-2Get rights and content

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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    1

    D.G. McLeod is a study investigator for AstraZeneca, Macclesfield, Cheshire, U.K. P. Iversen is a study investigator funded by AstraZeneca.

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