gyno on ADT?

Today my RO said Tamoxifen is a reasonable choice if I'm concerned. He cited the Italian study about effectiveness of Tamoxifen vs RT. He also said there've only been a couple of men in the last few years that selected RT to stop gynecomastia. Most prefer the drug instead. And, he said I should meet with my medical oncologist to pursue this, since it's not his area to manage.

So, I emailed my MO, and she called me within an hour or so. She said the best way to avoid the SEs of Casodex is to stop taking it! She wasn't a fan of adding Casodex originally, and wasn't in the loop when my urology oncologist prescribed it. So I explained the background, where my PSA hadn't declined as much as we hoped on Lupron alone (from 5.2 to 2.0 after 7 weeks on Lupron). So, Casodex was added.

I'll see her Friday for more conversation about this. I got the impression that if I still wanted it after she thoroughly reviews the side effects with me, she'd probably go along with it. But, we'll see.

Here ya go...

Serretta et al said...
Bicalutamide-induced breast events can be prevented to a significant degree by prophylaxis with TAM 10 mg/day or effectively treated with TAM therapy 20 mg/day.

Kunath et al said...
Prevention of breast events (p4)
All four studies (Fradet 2007, Perdona 2005, Boccardo 2005, and Saltzstein 2005) provided data on the prevention of gynecomastia and on breast pain for tamoxifen (10 mg or 20 mg daily) compared to no additional therapy or to placebo....

Treatment of breast events (p5)
One study (Saltzstein 2005) showed a significant difference favoring tamoxifen for the treatment of breast events (including gynecomastia/breast pain) at three months (RR 0.38, 95% CI 0.25 to 0.58, Table 4), and Perdona et al. (Perdona 2005) reported that tamoxifen significantly improved the symptoms of gynecomastia, breast pain or both compared with radiotherapy at nine months (RR 0.21, 95% CI 0.05 to 0.83, Table 4). Perdona et al. presented data for patients with grade 3-4 gynecomastia (> 4 cm) who experienced a change of disease to grade 1-2 gynecomastia (≤ 4 cm) [9] and Saltzstein et al. reported data for the time to resolution of breast events [13].

I hope it works for you.

- Allen

??
Gynecomastia is enlargement of men's breast. Improvement of that symptom means growth reversal. There's a chart in the review article that shows how before and after measurements were made with calipers.

You might want to get a second opinion before taking Megace (a progesterone). Megace has gynecomastia listed as a known side effect in 1-3% of people who took it:

www.drugs.com/sfx/megace-oral-suspension-side-effects.html

Well, we visited the medical oncologist today. She's still not really convinced the Casodex was necessary, but doesn't want to contradict the urology oncologist who prescribed it. He's more restrictive about prescribing things than she is, so she thought there must be some good reason for it. My PSA had dropped only to 2.0 after seven weeks on Lupron, so I had some concern that it wasn't responding well enough.

She cautioned that Tamoxifen raises a clotting risk, and need to be aware of it. Not common, but certainly not unheard of either. Kind of rare to have it, but it's pretty serious if it happens.

So, the idea now is to wait a month (I have no symptoms) and check the PSA level to verify that the Casodex is helping. If the PSA is low (like <0.5), we'll stay on it and consider adding the Tamoxifen then. If the PSA is still around 2.0, then we'll know the Casodex is not helping and it can just be stopped.

Thanks, Allen. I appreciate the references you use backing things up. They're invaluable when talking to my "evidence based" docs.

The good news is that my T is definitely below 20 (Yay, I'm chemically castrated! And in this twilight zone that's good news.... wow....). Checking at 7 weeks in, the GP's lab could only detect down to 20, and it was lower than that. They called me really concerned about my low T, and the doc wanted to see me as soon as possible! I told them I was really happy about that level, since I'm on Lupron. It appears my system responded nominally to Lupron, T levels followed the expected drop according to their literature.

It will be really interesting to see what my PSA is in a month, since that will be right after my IGRT series ends. Moobs shouldn't be happening that soon either, so waiting a month seems prudent.

I also understand that the question might really be how effective bicalutamide is for me, vs. just the category of anti-androgen in general. That's a good point I hadn't considered.

As most of you know I am starting HT in the next two weeks. The subject of preventing gynecomastia was one that I asked a lot of questions about and researched a bit.

The reason I chose prophylactic RT is because of what I read about the potential side effects of the drug. While some of the side effects pertain to women, the following applied to both men and women.

The primary intended use of Tamoxifen is used in the treatment and prevention of breast cancer.

The following side effects are common (occurring in greater than 30%) for patients taking tamoxifen:
• Hot flashes
• Swelling (fluid retention in feet, ankles, or hands)
• Loss of libido (particularly in men)

These side effects are less common side effects (occurring in about 10-29%) of patients receiving tamoxifen:
• Nausea
• Weight loss
• Mood changes (see anxiety and/or depression)

A rare, but serious side effect of tamoxifen is blood clots, including deep vein thrombosis (DVT) and pulmonary embolus. You should seek emergency help and notify your health care provider immediately if you develop sudden chest pain and shortness of breath. Notify your health care provider within 24 hours if you notice that one leg is swollen, red, painful and/or warm to touch and the other is not.

I figured I would have enough of a chance of experiencing most of these side effects from the Lupron/TAK700 combination and I didn't need to compound it with Tamoxifen.

Just FWI and my two cents,

Sonny

Herewith some thing else to consider from a drug interaction program that my oncologist commonly consults:

tamoxifen + abiraterone acetate

caution advised: combo may incr. tamoxifen levels, risk of adverse effects (hepatic metab. inhibited)

Houseboy

I know that Dr. Mark Scholtz prescribes the drug Femara (Letrazole) to both prevent as well as treat and, to a degree, reverse gynecomastia. One should notice results within 4 or 5 days of taking it. Side effects are minimal for most patients. My local Rite-Aid had to order it but there was a generic brand so it was inexpensive.