Prevention and management of bicalutamide-induced gynecomastia and breast pain: randomized endocrinologic and clinical studies with tamoxifen and anastrozole

Abstract

A randomized, double-blind, placebo-controlled multicenter trial involving 107 men receiving bicalutamide ('Casodex') 150 mg/day therapy following radical therapy for prostate cancer assessed tamoxifen ('Nolvadex') 20 mg/day and anastrozole ('Arimidex') 1 mg/day for the prophylaxis and treatment of gynecomastia/breast pain. Tamoxifen, but not anastrozole, significantly reduced the incidence of gynecomastia/breast pain when used prophylactically and therapeutically. Serum testosterone levels increased with tamoxifen relative to placebo but prostate-specific antigen levels declined in all treatment groups. Further studies are needed to define the optimum tamoxifen dose and to assess any impact on cancer control. The use of tamoxifen in this setting remains to be investigated.

Gynecomastia and Breast Pain Induced by Adjuvant Therapy With Bicalutamide After Radical Prostatectomy in Patients With Prostate Cancer: The Role of Tamoxifen and Radiotherapy

“…12 Tamoxifen was more effective than RT for preventing bicalutamide induced gynecomastia and breast pain. Our positive findings are in agreement with prior studies with different treatment schedules, such as those of Boccardo 12 and Saltzstein 13 et al, who administered 20 mg tamoxifen daily, and those of Eaton et al, who administered 20 mg weekly. 16 The incidence of gynecomastia in our trial was 34% after RT, lower than that reported by Tyrrell et al, who noted gynecomastia in 52% of the RT group, 14 and similar to that reported by Widmark et al, who observed gynecomastia in 28% of irradiated patients.…”

Management of Complications of Prostate Cancer Treatment

“…120,121 Tamoxifen is the most effective medical therapy for gynecomastia and/or mastodynia. 122,123 Breast reduction surgery may benefit the occasional man with severe breast symptoms that are refractory to medical treatment.…”

Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico

“…No hubo diferencias en la respuesta terapéuti-ca entre Gi fisiológica puberal y no puberal (patológica e idiopática del adulto), lo que sugiere en ambos casos la existencia de un desbalance 28,29 , lo que supondría que el bloqueo del receptor estrogénico es más importante que la disminución del estrógeno plasmático e intramamario. Fue exitoso el combinar tamoxifeno con el antiandrógeno que produjo Gi durante la terapia del acné.…”

“…Fue exitoso el combinar tamoxifeno con el antiandrógeno que produjo Gi durante la terapia del acné. Resultados similares se reportaron con tamoxifeno-flutamida 30 y tamoxifeno-bicalutamida 29 en Gi desarrollada durante terapia con antiandrógenos en cáncer prostático. Se ha señala-do que las Gi con diámetro máximo ≥ 4 cm no regresarían con antiestrógenos 18 , nuestro 52% de desaparición de Gi ≥ 4 cm indicaría que el mayor tamaño no impide utilizarlos.…”