Does prophylactic breast irradiation prevent antiandrogen-induced gynecomastia? Evaluation of 253 patients in the randomized Scandinavian trial SPCG-7/SFUO-3.
OBJECTIVE
To examine the development of antiandrogen-induced gynecomastia and breast tenderness in the first 253 patients in a randomized Scandinavian trial (SPCG-7/SFUO-3) with a 12-month complete follow-up evaluation performed by both doctors and patients.


METHODS
In this study, the treating doctor and patient decided whether prophylactic irradiation (RT) of the breast should be given to prevent antiandrogen-induced gynecomastia. At each visit, the doctor evaluated the occurrence of gynecomastia and breast tenderness. Questions about gynecomastia and breast tenderness were also included in the study quality-of-life questionnaire (Prostate Cancer Symptom Scale).


RESULTS
Mammary RT with mostly single fraction (12 to 15 Gy) electrons was given to 174 (69%) of the 253 evaluated patients. At the 1-year follow-up visit, the doctor evaluations indicated some form of gynecomastia in 71% and 28% (P <0.001) of the nonirradiated (no-RT) and irradiated (RT) patients, respectively. The patient evaluations at 1 year showed some form of breast enlargement in 78% and 44% (P <0.001) of the no-RT and RT patients, respectively. The doctors reported some form of breast tenderness at 1 year in 75% and 43% (P <0.001) of the no-RT and RT patients, respectively. The patient evaluations of breast tenderness show an expected significant increase in the RT arm at the 3-month follow-up, which was probably due to skin reactions. At 1 year, significantly more patients who marked "very much" on the Prostate Cancer Symptom Scale were seen in the no-RT group. A weak correlation between the doctors' and patients' detection of breast problems was observed.


CONCLUSIONS
The results show that, with high significance, prophylactic RT of the breast decreases the risk of antiandrogen-induced gynecomastia and breast tenderness.
Widmark
A
A
Department of Oncology, Umeå University, Umeå, Sweden.
Fosså
S D
SD
Lundmo
P
P
Damber
J-E
JE
Vaage
S
S
Damber
L
L
Wiklund
F
F
Klepp
O
O
D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D001940:Breast / Q000528:radiation effects*; D001941:Breast Diseases / Q000517:prevention & control; D005500:Follow-Up Studies; D006177:Gynecomastia / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D006304:Health Status; D006801:Humans; D008297:Male; D010146:Pain / Q000517:prevention & control; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D011878:Radiotherapy; D012537:Scandinavian and Nordic Countries; D011795:Surveys and Questionnaires
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal