Patients with
prostate cancer treated with small-molecular,
nonsteroidal anti-androgens frequently develop
mammalgia and
gynecomastia. To avoid these unwanted effects, pretherapeutic
radiation therapy of the male breasts is in common use. Recent findings on the effectivity of prevention and treatment of
breast pain and
gynecomastia, by both
radiation therapy and
tamoxifen, and a new comparative study, necessitate a re-evaluation of current prophylactic and therapeutic treatment options. An evidence-based treatment algorithm is derived that diverges from previous recommendations and redefines the role of preventive and therapeutic
radiation therapy. For the propylaxis of
gynecomastia and
breast pain,
tamoxifen is superior to single-dose
radiation therapy with 10 Gy. Hence, if
tamoxifen for this indication should prove to be safe on longer follow-up,
radiation therapy would only be indicated in situations where
tamoxifen therapy is impossible or contraindicated. The same is proposed for the treatment of early
gynecomastia or
breast pain except with
tamoxifen treatment failure as an additional indication. Higher radiation doses of 4 x 5 Gy, which were shown to be effective in this setting, have not yet been evaluated against anti-
estrogen therapy.