Gynecomastia in Patients with Prostate Cancer: A Systematic Review

Abstract

IntroductionGynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients’ quality of life.AimsTo systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients’ quality of life.MethodsThe PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:”gynecomastia AND treatment AND prostate cancer”. Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design) process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE.Main Outcome MeasuresPrimary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life.ResultsEleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high.ConclusionsBicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10–20 mg daily) or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy.

Treatment strategies to prevent and reduce gynecomastia and/or breast pain caused by antiandrogen therapy for prostate cancer

“…Nonsteroidal antiandrogens like bicalutamide or flutamide block androgen receptors, which through a feedback loop increase the secretion of luteinizing hormone (LH). Increased LH stimulates testosterone secretion, which, however, is then converted to estrogen by peripheral aromatization [4]. As androgen receptors are blocked by nonsteroidal antiandrogens, the increased level of estrogen stimulating the estrogen receptor in breast tissue stimulates growth, leading to gynecomastia and/or breast pain [4].…”

“…Alternatively, gynecomastia and/or breast pain can be treated by drug intervention using either tamoxifen (TMX) which blocks the estrogen receptor, or theoretically by anastrozole which inhibits the peripheral aromatization of androgens into estrogens. Surgery might also be a treatment option but due to its invasiveness is commonly preserved for those patients were aforementioned treatments have failed [1,4]. The literature supporting the use of these treatment approaches is reviewed in the following.…”

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

“…Gynaecomastia and breast pain are common adverse effects of non-steroidal anti-androgen therapy (bicalutamide, flutamide), and less so, GnRHa therapy, that can seriously impact men's masculinity and quality of life (9,59). Three systematic reviews analysed the incidence data (14,15,57).…”

Music Intervention Can Improve Emotion in Cancer Patients during Disease Progression

“…In our study, we established P (population) for cancer patients; I (intervention) for music-based intervention; C for comparison of music intervention with another type of intervention or untreated group; O for management of emotion changes and disease progress; S for exception of cross-sectional studies and surveys studies [13,14].…”