Low rate of clinician-scored gynecomastia induced by 6 months of combined androgen blockade in a randomized trial: Implications for prophylactic breast irradiation.

Abstract

PURPOSE:

To determine the incidence and predictors of clinician-scored gynecomastia induced by 6 months of combined androgen blockade (CAB) in a randomized trial.

METHODS:

We studied 94 men with intermediate or high-risk prostate cancer randomized to radiation plus 6 months of neoadjuvant CAB consisting of a gonadotropin-releasing hormone agonist and antiandrogen (flutamide). Patients were assessed for breast symptoms monthly as per protocol. Patients reporting breast tenderness or enlargement were then examined shirtless.

RESULTS:

Median age at entry was 72.1 years. While 52 patients (55.3%) reported either breast tenderness or enlargement, only 9 patients (9.6%) were scored as having gynecomastia when examined shirtless by a single clinician. Four patients received radiation for self-reported breast tenderness or enlargement without clinician-scored gynecomastia. If these 4 had not been radiated, the total incidence of clinician-scored gynecomastia may have been as high as 13 of 94 (13.8%). No patient variable, such as age, body-mass index, and Adult Comorbidity Evaluation-27 score, or discontinuation of the antiandrogen, was associated with the development of gynecomastia.

CONCLUSIONS:

While many patients self-reported breast tenderness or enlargement with short-course CAB, the incidence of breast enlargement noticeable to an examiner when the patient was shirtless was less than 15%, which is much lower than the 60% to 80% rates typically reported with antiandrogen monotherapy. Given that the long-term risks of prophylactic breast irradiation are not well characterized, these data suggest that prophylactic breast irradiation may not be as necessary in men receiving short-course CAB.

• Authors: Amar U Kishan, Ming-Hui Chen, Marian Loffredo, Dongsun Kim, Clair J Beard, Mark D Hurwitz, Neil E Martin, Peter F Orio 3rd, Philip W Kantoff, Anthony V D'Amico, Paul L Nguyen
• Journal: Practical radiation oncology (Pract Radiat Oncol) 2012 Jul-Sep Vol. 2 Issue 3 Pg. 172-178 ISSN: 1879-8519 [Electronic] United States
• PMID: 24674120 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.