Incidence and management of gynecomastia in men treated for prostate cancer.
Incidence and management of gynecomastia in men treated for prostate cancer.
复制标题
接受前列腺癌治疗的男性男性乳房发育症的发病率和治疗。
DOI：
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发表时间：
2005
影响因子：
6.6
通讯作者：
Malcolm J. M. Darkes
中科院分区：
文献类型：
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作者：
A. Dobs;Malcolm J. M. Darkes
目的
男性乳房发育症是接受激素治疗前列腺癌的男性的潜在治疗限制性不良事件。
材料和方法
在大型、随机、安慰剂对照研究中，大约50%或更多的前列腺癌患者由于多种机制而经历男性乳房发育。虽然其严重程度大多报告为轻度至中度，但男性乳房发育被认为是大多数过早退出治疗的原因。在晚期前列腺癌患者中，双侧睾丸切除术与男性乳房发育症的发生率最低相关，其次是非甾体抗雄激素治疗、己烯雌酚和雌激素。
结果
重要的是，男性乳房发育症是谁想要进行激素治疗的前列腺癌患者得到很好的管理。应评估患者可能的男性乳房发育症的病因，并应制定预防性治疗或治疗男性乳房发育症。预防性放疗已被证明可以减少激素诱导的男性乳房发育症的发病率超过50%。另一种可能对患者更方便的治疗方法是预防性使用他莫昔芬。他莫昔芬也可以减轻或解决男性乳房发育在其早期或增殖阶段。在严重的长期男性乳房发育症手术是必要的，因为药物治疗是不太可能成功。芳香酶抑制剂和4-羟基他莫昔芬正在研究中。
结论
男性乳房发育是一个重大的问题，在男性接受激素治疗前列腺癌。它需要迅速得到承认、评价和管理。
PURPOSE
Gynecomastia is a potentially treatment limiting adverse event in men receiving hormone therapy for prostate cancer.
MATERIALS AND METHODS
In large, randomized, placebo controlled studies approximately 50% or more of patients with prostate cancer experienced gynecomastia due to multiple mechanisms. Although its severity was mostly reported as mild to moderate, gynecomastia was cited as the reason for most premature withdrawals from therapy. In patients with advanced forms of prostate cancer bilateral orchiectomy was associated with the lowest incidence of gynecomastia, followed by nonsteroidal antiandrogen therapy, diethylstilbestrol and estrogen in rank order.
RESULTS
It is important that gynecomastia is well managed in patients with prostate cancer who want to proceed with hormone therapy. Patients should be assessed for the likely etiology of gynecomastia and preventive therapy or treatment for established gynecomastia should be instituted. Prophylactic radiotherapy has been shown to decrease the incidence of hormone induced gynecomastia by more than 50%. An alternative course of action, which may be more convenient for the patient, is the prophylactic use of tamoxifen. Tamoxifen may also mitigate or resolve gynecomastia during its early or proliferative phase. In severe long-standing gynecomastia surgery is warranted since medical therapies are less likely to succeed. Aromatase inhibitors and 4-hydroxytamoxifen are investigational.
CONCLUSIONS
Gynecomastia is a significant problem in men undergoing hormonal therapy for prostate cancer. It requires prompt recognition, evaluation and management.