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TAMOXIFEN AS TREATMENT FOR GYNECOMASTIA AND MASTODYNIA RESULTING FROM HORMONAL DEPRIVATION
0022-5347/98/1594-1309$03.00/0
THE JOURNAL OF UROLDGY
Vol. 169, 1309. April 1998 Rintod in U.SA.
Copyright 0 1998 by AMERICAN UROUW~ICAL ASS~CUTION,INC.
TAMOXIFEN AS TREATMENT FOR GYNECOMASTIA AND MASTODYNIA RESULTING FROM HORMONAL DEPRIVATION SCOTT SERELS AND ARNOLD MELMAN From the Department of Urology, Montefiore Medical Center, Bronx, New York
KEY WORDS: tamoxifen, hormones, gynecomastia, breast, pain
The standard care for patients with metastatic disease or inoperable prostate cancer is orchiectomy or the administration of luteinizing hormone releasing hormone agonists with or without an antiandrogen. With the use of leuprolide the reported incidence of gynecomastia and breast pain has ranged from 3 to 12.7%.lS2 Mastodynia in women has been treated with local support, dietary changes (low salt diets, vitamins and so forth) and/or hormonal manipulation. Fentimen et al reported a trial using 20 mg. tamoxifen, an estrogen receptor blocker, and com1 pared it to placebo for the treatment of ma~todynia.~ They obtained a 71% success rate with tamoxifen compared to 29% with placebo. This same group showed that 10 mg. could be as effective as 20 mg. tamoxifen with less side effects. Thus, it seems that 10 or 20 mg. tamoxifen may be used for the treatment of mastodynia. Some of the side effects reported are nausea, malaise, urticaria, alopecia, weight gain, depression, hot flashes, liver enzyme changes and irritability. We decided to try tamoxifen for the treatment of gynecomastia and breast pain in men with prostate cancer during androgen deprivation. A decrease and/or resolution of gynecomastia and/or pain was considered a good response to treatment.
hormone agonist he started having breast pain and enlargement, which improved considerably subjectively and objectively in approximately 1month with 20 mg. tamoxifen daily. Presently the patient is continuing on this therapy. Case 3. A 73-year-old man who was diagnosed with stage D prostate cancer had breast pain and gynecomastia a year after orchiectomy. He was started on 10 mg.tamoxifen daily with improvement in symptoms within 6 weeks and he continues on this regimen. DISCUSSION
Gynecomastia and breast pain are known side effects of hormonal deprivation in the treatment of prostate cancer. The etiology of gynecomastia and mastdynia in men who are deprived of testosterone has yet to be elucidated. It may occur because estrogens are not balanced by testosterone secretion. Tamoxifen, an antiestrogen, has been used with success in women with rnastodynia. To our knowledge we report for the first time that this treatment can be effective in men who are undergoing hormonal deprivation. Further confirmatory studies are needed. Furthermore, the optimum course and frequency at which this therapy should be repeated are yet to be elucidated.
CASE REPORTS
Case 1. A 63-year-old man with a history of metastatic prostate cancer had gynecomastia 3 months after orchiectomy. A dosage of 10 mg. tamoxifen twice daily was administered with resolution of the gynecomastia within a month. Two months later the tamoxifen was discontinued due to an elevation in alkaline phosphatase. To date the gynecomastia has not recurred. Case 2. A 66-year-old man was diagnosed with T2B prostate cancer. After 2 years on a luteinizing hormone releasing Accepted for publication September 19,1997.
REFERENCES
1. Crawford, E. D., Eisenberger, M. A., McLeod, D., Spaulding, J. T., Bensons, R., Dorr, F. A., Blumenstein, B. A. , Davis, M. A. and Goodman, P. J.: A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. New Engl. J. Med., 321: 419, 1989. 2. The Leuprolide Study Group: Leuprolide versus diethyhtilbestrol for metastatic prostate cancer. New Engl. J. Med., 311: 1281,1984. 3. Fentiman, I. S., Caleffi, M., Hamed, H.and Chaudary, M. A.: Studies of tamoxifen in women with mastalgia. Brit. J. Clin. Pract., suppl., 88: 34, 1989.
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THE JOURNAL OF UROLDGY
Vol. 169, 1309. April 1998 Rintod in U.SA.
Copyright 0 1998 by AMERICAN UROUW~ICAL ASS~CUTION,INC.
TAMOXIFEN AS TREATMENT FOR GYNECOMASTIA AND MASTODYNIA RESULTING FROM HORMONAL DEPRIVATION SCOTT SERELS AND ARNOLD MELMAN From the Department of Urology, Montefiore Medical Center, Bronx, New York
KEY WORDS: tamoxifen, hormones, gynecomastia, breast, pain
The standard care for patients with metastatic disease or inoperable prostate cancer is orchiectomy or the administration of luteinizing hormone releasing hormone agonists with or without an antiandrogen. With the use of leuprolide the reported incidence of gynecomastia and breast pain has ranged from 3 to 12.7%.lS2 Mastodynia in women has been treated with local support, dietary changes (low salt diets, vitamins and so forth) and/or hormonal manipulation. Fentimen et al reported a trial using 20 mg. tamoxifen, an estrogen receptor blocker, and com1 pared it to placebo for the treatment of ma~todynia.~ They obtained a 71% success rate with tamoxifen compared to 29% with placebo. This same group showed that 10 mg. could be as effective as 20 mg. tamoxifen with less side effects. Thus, it seems that 10 or 20 mg. tamoxifen may be used for the treatment of mastodynia. Some of the side effects reported are nausea, malaise, urticaria, alopecia, weight gain, depression, hot flashes, liver enzyme changes and irritability. We decided to try tamoxifen for the treatment of gynecomastia and breast pain in men with prostate cancer during androgen deprivation. A decrease and/or resolution of gynecomastia and/or pain was considered a good response to treatment.
hormone agonist he started having breast pain and enlargement, which improved considerably subjectively and objectively in approximately 1month with 20 mg. tamoxifen daily. Presently the patient is continuing on this therapy. Case 3. A 73-year-old man who was diagnosed with stage D prostate cancer had breast pain and gynecomastia a year after orchiectomy. He was started on 10 mg.tamoxifen daily with improvement in symptoms within 6 weeks and he continues on this regimen. DISCUSSION
Gynecomastia and breast pain are known side effects of hormonal deprivation in the treatment of prostate cancer. The etiology of gynecomastia and mastdynia in men who are deprived of testosterone has yet to be elucidated. It may occur because estrogens are not balanced by testosterone secretion. Tamoxifen, an antiestrogen, has been used with success in women with rnastodynia. To our knowledge we report for the first time that this treatment can be effective in men who are undergoing hormonal deprivation. Further confirmatory studies are needed. Furthermore, the optimum course and frequency at which this therapy should be repeated are yet to be elucidated.
CASE REPORTS
Case 1. A 63-year-old man with a history of metastatic prostate cancer had gynecomastia 3 months after orchiectomy. A dosage of 10 mg. tamoxifen twice daily was administered with resolution of the gynecomastia within a month. Two months later the tamoxifen was discontinued due to an elevation in alkaline phosphatase. To date the gynecomastia has not recurred. Case 2. A 66-year-old man was diagnosed with T2B prostate cancer. After 2 years on a luteinizing hormone releasing Accepted for publication September 19,1997.
REFERENCES
1. Crawford, E. D., Eisenberger, M. A., McLeod, D., Spaulding, J. T., Bensons, R., Dorr, F. A., Blumenstein, B. A. , Davis, M. A. and Goodman, P. J.: A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. New Engl. J. Med., 321: 419, 1989. 2. The Leuprolide Study Group: Leuprolide versus diethyhtilbestrol for metastatic prostate cancer. New Engl. J. Med., 311: 1281,1984. 3. Fentiman, I. S., Caleffi, M., Hamed, H.and Chaudary, M. A.: Studies of tamoxifen in women with mastalgia. Brit. J. Clin. Pract., suppl., 88: 34, 1989.
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