Prophylactic breast irradiation with a single dose of electron beam radiotherapy (10 Gy) significantly reduces the incidence of bicalutamide-induced gynecomastia

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

“…17 These differences in the results can be probably attributed to the difference in the radiation 15 This difference may have been due to the difference in the number of RT fractions (12 Gy as a single fraction vs 2 fractions of 6 Gy each). 18 RT related adverse events were seen in 40% of 35 patients and they were similar to those observed in previous studies, 14,15 All were transient and resolved spontaneously. When designing this trial, the aim was to minimize the risk of adverse events and also minimize patient inconvenience by administering a single low dose of radiation.…”

“…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. 17 These differences in the results can be probably attributed to the difference in the radiation 15 This difference may have been due to the difference in the number of RT fractions (12 Gy as a single fraction vs 2 fractions of 6 Gy each).…”

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

“…3 A recent randomized study has demonstrated that a single dose of prophylactic irradiation (10 Gy) is effective in reducing the incidence of gynecomastia in bicalutamide-treated patients. 5 Similar results were reported from a recent Scandinavian study in which 69% of patients received prophyalctic irradiation for gynecomastia induced by the nonsteroidal antiandrogen flutamide. 6 Hormonal therapies that reduce estrogen activity at the breast (Figure 1), such as the aromatase inhibitors, which block the peripheral aromatization of circulating androgens to estrogens, and the antiestrogens, which are antagonists at the estrogen receptors, should also reduce the tendency for gynecomastia to occur in the presence of androgen blockade.…”

Bicalutamide (‘Casodex’) 150 mg in addition to standard care in patients with nonmetastatic prostate cancer: updated results from a randomised double-blind phase III study (median follow-up 5.1 y) in the early prostate cancer programme

“…However, there are also various prophylactic and therapeutic strategies available for the management of gynaecomastia and breast pain, including tamoxifen 20,21 and breast irradiation. 22,23 There is a potential concern that patients with early prostate cancer who show evidence of disease progression following first-line antiandrogen monotherapy will not respond to subsequent hormonal manipulation. However, recent evidence from a subset of patients within the EPC programme, reveals that approximately 55% of those who progressed on bicalutamide showed a PSA response (defined as a reduction in PSA X20% at X3 months post initiation of second-line therapy) to second-line hormonal therapy, mostly castration-based therapies.…”