Prostate news article, November 2005
INCIDENCE AND MANAGEMENT OF GYNAECOMASTIA IN MEN TREATED FOR PROSTATE CANCER Article in The Journal of Urology, November 2005 Reviewed by: Mr Joe Nariculam, MBBS, MRCS |
Gynaecomastia is defined as an abnormal enlargement of one or both breasts in men, usually due to hormone imbalance. Gynaecomastia is a potentially treatment limiting adverse event in men receiving hormone therapy for prostate cancer. Published in the November issue of the Journal of Urology, The Johns Hopkins School of Medicine, Baltimore, USA and the Rainbow Beach Pharmacy, Queensland, Australia initiated a randomised study looking at the incidence of gynaecomastia in patients undergoing treatment for prostate cancer.
Gynaecomastia can have a physical and mental effect on patients, who may become self-conscious and embarrassed. It decreases quality of life by causing physical pain and emotional discomfort. More than 11,000 patients treated for prostate cancer were retrospectively analysed using a randomised, placebo controlled study, involving the two centres.
The study showed that 50% or more of patients treated for prostate cancer experienced gynaecomastia due to multiple mechanisms. Though the severity of gynaecomastia was reported as mainly mild to moderate, gynaecomastia was cited as the reason for most premature withdrawals from therapy. Removal of both testes (bilateral orchidectomy) was associated with the lowest incidence of gynaecomastia, followed by non-steroidal anti-testosterone therapy (casodex). Patients treated with oestrogens were found to have the highest incidence of gynaecomastia.
The study stressed the importance of managing gynaecomastia in patients with prostate cancer. Prophylactic radiotherapy has shown to decrease the incidence of hormone induced gynaecomastia by more than 50%. An alternative, which would be more convenient for patients, is the prophylactic use of tamoxifen tablets.
The paper concludes that gynaecomastia is a significant problem in men undergoing hormonal therapy for prostate cancer, requiring prompt recognition, evaluation and management.
Adrian Dobs and Malcolm J M Darkes,
The Journal of Urology, November 2005; 174, 1737-1742.