title: Gynecomastia in Patients with Prostate Cancer: A Systematic Review.
abstract: BACKGROUND
  Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients' quality of life.
  
  
  OBJECTIVE
  To systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients' quality of life.
  
  
  METHODS
  The PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:"gynecomastia AND treatment AND prostate cancer". Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design) process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE.
  
  
  METHODS
  Primary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life.
  
  
  RESULTS
  Eleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high.
  
  
  CONCLUSIONS
  Bicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10-20 mg daily) or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy.
authors: Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Anders
authors: A
authors: Fagerlund
authors: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors: Luigi
authors: L
authors: Cormio
authors: Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Lina
authors: L
authors: Palangi
authors: Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Richard
authors: R
authors: Lewin
authors: Plastic Surgery Unit, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy.
authors: Fabio
authors: F
authors: Santanelli di Pompeo
authors: Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Anna
authors: A
authors: Elander
authors: Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, at Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Gennaro
authors: G
authors: Selvaggi
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects*; D006177:Gynecomastia / Q000139:chemically induced*; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy; D011788:Quality of Life
chemical_list: D000726:Androgen Antagonists