Gynecomastia treatment in prostate cancer

The authors determined the treatment options available for gynecomastia in prostate cancer patients. 

Hormone therapy is a common treatment for prostate cancer. It targets the male sex hormones active in prostate cancer, such as testosterone. Bicalutamide (Casodex, Cosudex, Calutide) is a common hormonal drug used in prostate cancer. In certain patients, treatment with bicalutamide can cause gynecomastia. Gynecomastia is an enlargement of a man’s breast, typically due to hormone imbalance or hormone therapy.

Further studies are needed to determine treatment effects, complications and side-effects in patients who develop breast enlargement.

The aim of this review was to identify treatments available for prostate cancer patients who develop breast enlargement after hormone-therapy.

11 articles were analyzed in this review.

Daily treatment with tamoxifen (Nolvadex) in combination with bicalutamide was  highly effective in preventing the occurrence of breast enlargement and breast pain. Some studies reported that preventive treatment with tamoxifen reduced the risk of bicalutamide-related breast events by 3.22 times. The same study reported that 65.4% of patients treated daily with tamoxifen experienced reduction in breast enlargement and breast pain. One other study reported that tamoxifen reduced the risk of breast events by up to 6 or 7 times compared to control group (paients receiving placebo-a harmless pill instead of tamoxifen). In one separate study, side-effects to tamoxifen treatment occurred in 35% of patients. 

Preventive radiotherapy (directs a beam of radiation at the target site to kill diseased cells) was used in three studies to manage breast enlargement. There was a 28-50% reduction in breast enlargement in the radiotherapy group. This was compared to 71-85% in the control group. Another study reported a 15.8% reduction in breast enlargement compared to 50% in the control group. Two studies reported a 36-43% reduction in breast pain compared to 49-75% in the control group.

Treatment with tamoxifen or radiotherapy did not reduce patients' quality of life (social, mental and physical function) or reduce sexual function. 

The authors concluded that treatment with tamoxifen or radiotherapy successfully managed bicalutamide-induced breast enlargement.