Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Gynecomastia in patients with prostate cancer: update on treatment options

Prostate Cancer and Prostatic Diseases volume 9, pages 109–114 (2006)Cite this article

Abstract

Non-steroidal antiandrogen monotherapy offers potential quality of life benefits over other treatment modalities in patients with prostate cancer. Nevertheless, gynecomastia and breast pain still represent the most bothersome side effects during this treatment. In this update article, recent advances in the management options for gynecomastia/breast pain caused by hormonal manipulation are reviewed and critically analyzed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Iversen P, Melezinek I, Schmidt A . Nonsteroidal antiandrogens: a therapeutic option for patients with advanced prostate cancer who wish to retain sexual interest and function. BJU Int 2001; 87: 47–56.

    Article  CAS  Google Scholar 

  2. Kaisary AV . Evaluating the use of early hormonal therapy in patients with localised or locally advanced prostate cancer. Prostate Cancer Prostatic Dis 2005; 8: 140–151.

    Article  CAS  Google Scholar 

  3. Wirth MP, See WA, McLeod DG, Iversen P, Morris T, Carroll K . Bicalutamide 150 mg in addition to standard care in patients with localized or locally advanced prostate cancer: results from the second analysis of early prostate cancer program at median follow-up of 5.4 years. J Urol 2004; 172: 1865–1870.

    Article  CAS  Google Scholar 

  4. Tyrrell CJ . Gynecomastia: aetiology and treatment options. Prostate Cancer Prostatic Dis 1999; 2: 167–171.

    Article  CAS  Google Scholar 

  5. Pavone-Macaluso M, de Voogt HJ, Viaggiano G, Barasolo E, Lardennois B, de Pauw M et al. Comparison of diethylstilbestrol, cyproterone acetate and medroxyprogesterone acetate in the treatment of advanced prostate cancer: final analysis of a randomized phase III trial of the European Organization for Research on Treatment of Cancer Urological Group. J Urol 1986; 136: 624–631.

    Article  CAS  Google Scholar 

  6. Schroder FH, Whelan P, de Reijke TM, Kurth KH, Pavone-Macaluso M, Mattelaer J et al. Metastatic prostate cancer treated by flutamide versus cyproterone acetate. Final analysis of the ‘European Organization for Research and Treatment of Cancer' (EORTC) Protocol 30892. Eur Urol 2004; 45: 457–464.

    Article  CAS  Google Scholar 

  7. Chang A, Yeap B, Davis T, Blum R, Hahn R, Khanna O et al. Double blind, randomized study of primary hormonal treatment of stage D2 prostate carcinoma: flutamide versus diethylstilbestrol. J Clin Oncol 1996; 14: 2250–2257.

    Article  CAS  Google Scholar 

  8. Oosterlinck W, Casselman J, Mattelaer J, van Velthoven R, Kurjatkin O, Schulman C . Tolerability and safety of flutamide in monotherapy, with orchiectomy or with LHRH – a in advanced prostate cancer patients. A Belgian multicenter study of 905 patients. Eur Urol 1996; 30: 458–463.

    Article  CAS  Google Scholar 

  9. Boccon-Gibod L, Fournier G, Bottet P, Marechal JM, Guiter J, Rischman P et al. Flutamide versus orchiectomy in the treatment of metastatic prostate carcinoma. Eur Urol 1997; 32: 391–396.

    PubMed  CAS  Google Scholar 

  10. Barqawi AB, Moul JW, Ziada A, Handel L, Crawford ED . Combination of low-dose flutamide and finasteride for PSA-only recurrent prostate cancer after primary therapy. Urology 2003; 62: 872–876.

    Article  Google Scholar 

  11. Decensi AU, Boccardo F, Guarneri D, Positano N, Paoletti MC, Costantini M et al. Monotherapy with nilutamide, a pure non-steroidal antiandrogen, in untreated patients with metastatic carcinoma of the prostate. The Italian Prostatic Cancer Project. J Urol 1991; 146: 377–381.

    Article  CAS  Google Scholar 

  12. Robinson MR, Smith PH, Richards B, Newling DW, de Pauw M, Sylvester R . The final analysis of the EORTC Genito-Urinary Tract Cancer Co-Operative Group phase III clinical trial (protocol 30805) comparing orchidectomy, orchidectomy plus cyproterone acetate and low dose stilboestrol in the management of metastatic carcinoma of the prostate. Eur Urol 1995; 28: 273–283.

    Article  CAS  Google Scholar 

  13. Oh WK, Kantoff PW, Weinberg V, Jones G, Rini BI, Derynck MK et al. Prospective, multicenter, randomized phase II trial of the herbal supplement, PC-SPES, and diethylstilbestrol in patients with androgen-independent prostate cancer. Clin Oncol 2004; 22: 3705–3712.

    Article  CAS  Google Scholar 

  14. Iversen P, Christensen MG, Friis E, Hornbol P, Hvidt V, Iversen HG et al. Phase III trial of Zoladex and flutamide versus orchiectomy in the treatment of patients with advanced carcinoma of the prostate. Cancer 1990; 66 (Suppl): 1058–1066.

    Article  CAS  Google Scholar 

  15. Denis LJ, Keuppens F, Smith PH, Whelan P, de Moura JL, Newling D et al. Maximal androgen blockade: final analysis of EORTC phase III trial 30853. EORTC Genito-Urinary Tract Cancer Cooperative Group and the EORTC Data Center. Eur Urol 1998; 33: 144–151.

    Article  CAS  Google Scholar 

  16. Kaisary AV, Tyrrell CJ, Peeling WB, Griffiths K . Comparison of LHRH analogue (Zoladex) with orchiectomy in patients with metastatic prostatic carcinoma. Br J Urol 1991; 67: 502–508.

    Article  CAS  Google Scholar 

  17. Tyrrell CJ, Altwein JE, Klippel F, Varenhorst E, Lunglmayr G, Boccardo F et al. A multicenter randomized trial comparing the luteinizing hormone-releasing hormone analogue goserelin acetate alone and with flutamide in the treatment of advanced prostate cancer. The International Prostate Cancer Study Group. J Urol 1991; 146: 1321–1326.

    Article  CAS  Google Scholar 

  18. Iversen P, Tyrrell CJ, Kaisary AV, Anderson JB, Baert L, Tammela T et al. Casodex (bicalutamide) 150-mg monotherapy compared with castration in patients with previously untreated nonmetastatic prostate cancer: results from two multicenter randomized trials at a median follow-up of 4 years. Urology 1998; 51: 389–396.

    Article  CAS  Google Scholar 

  19. Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA et al. A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med 1989; 321: 419–424.

    Article  CAS  Google Scholar 

  20. Rizzo M, Mazzei T, Mini E, Bartoletti R, Periti P . Leuprorelin acetate depot in advanced prostatic cancer: a phase II multicentre trial. J Int Med Res 1990; 18 (Suppl 1): 114–125.

    Article  Google Scholar 

  21. Klioze SS, Miller MF, Spiro TP . A randomized, comparative study of buserelin with DES/orchiectomy in the treatment of stage D2 prostatic cancer patients. Am J Clin Oncol 1988; 11 (Suppl 2): S176–S182.

    Article  Google Scholar 

  22. Boccardo F, Barichello M, Battaglia M, Carmignani G, Comeri G, Ferraris V et al. Bicalutamide monotherapy versus flutamide plus goserelin in prostate cancer: updated results of a multicentric trial. Eur Urol 2002; 42: 481–490.

    Article  CAS  Google Scholar 

  23. Prezioso D, Piccirillo G, Galasso R, Altieri V, Mirone V, Lotti T . Gynecomastia due to hormone therapy for advanced prostate cancer: a report of ten surgically treated cases and a review of treatment options. Tumori 2004; 90: 410–415.

    Article  Google Scholar 

  24. Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K . Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery 2002; 131 (Suppl): S324–S329.

    Article  Google Scholar 

  25. Widmark A, Fossa SD, Lundmo P, Damber JE, Vaage S, Damber L et al. Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the Randomized Scandinavian Trial SPCG-7/SFUO-3. Urology 2003; 61: 145–151.

    Article  CAS  Google Scholar 

  26. Tyrrell CJ, Payne H, Tammela TL, Bakke A, Lodding P, Goedhals L et al. Prophylactic breast irradiation with a single dose of electron beam radiotherapy (10 Gy) significantly reduces the incidence of bicalutamide-induced gynecomastia. Int J Radiat Biol Phys 2004; 60: 476–483.

    Article  Google Scholar 

  27. Perdonà S, Autorino R, De Placido S, D'Amiento M, Gallo L, Damiano R et al. Efficacy of tamoxifen and radiotherapy for prevention and treatment of gynaecomastia and breast pain caused by bicalutamide in prostate cancer: a randomised controlled trial. Lancet Oncol 2005; 6: 295–300.

    Article  CAS  Google Scholar 

  28. Van Poppel H, Tyrrell CJ, Haustermans K, Cangh PV, Keuppens F, Colombeau P et al. Efficacy and tolerability of radiotherapy as treatment for bicalutamide-induced gynaecomastia and breast pain in prostate cancer. Eur Urol 2005; 47: 587–592.

    Article  CAS  Google Scholar 

  29. Serels S, Melman A . Tamoxifen as treatment for gynecomastia and mastodynia resulting from hormonal deprivation. Urology 1998; 159: 1309–1311.

    Article  CAS  Google Scholar 

  30. Braunstein GD . Aromatase and gynecomastia. Endocr Relat Cancer 1999; 6: 315–324.

    Article  CAS  Google Scholar 

  31. Eaton AC, Makris A, Makris A . Once weekly tamoxifen in the prevention of gynaecomastia and breast pain secondary to bicalutamide therapy. J Urol 2004; 171: 282.

    Article  Google Scholar 

  32. Boccardo F, Rubagotti A, Battaglia M, Di Tonno P, Selvaggi FP, Conti G et al. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol 2005; 23: 808–815.

    Article  CAS  Google Scholar 

  33. Saltzstein D, Sieber P, Morris T, Gallo J . Prevention and management of bicalutamide-induced gynecomastia and breast pain: randomized endocrinologic and clinical studies with tamoxifen and anastrozole. Prostate Cancer Prostatic Dis 2005; 8: 75–83.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinica Urologica, Seconda Università degli Studi, Napoli, Italy

    R Autorino, M D'Armiento, M De Sio & L Cosentino

  2. UO Urologia, INT, Fondazione G Pascale IRCSS, Napoli, Italy

    S Perdonà

  3. Cattedra di Urologia, Università Magna Graecia, Catanzaro, Italy

    R Damiano

  4. Cattedra di Oncologia Medica, Università degli Studi Federico II, Napoli, Italy

    G Di Lorenzo

Authors
  1. R Autorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Perdonà
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M D'Armiento
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M De Sio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Damiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L Cosentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G Di Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R Autorino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Autorino, R., Perdonà, S., D'Armiento, M. et al. Gynecomastia in patients with prostate cancer: update on treatment options. Prostate Cancer Prostatic Dis 9, 109–114 (2006). https://doi.org/10.1038/sj.pcan.4500859

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.pcan.4500859

Keywords

This article is cited by

Search

Advanced search

Quick links