tamoxifen or prophylactic radiation therapy?

[pwallace]

tamoxifen or prophylactic radiation therapy -- which one did you choose while taking bicalutamide? my husband will be taking bicalutamide for two years & is trying to decide between tamoxifen or prophylactic radiotherapy to prevent gynecomastia. he's attracted to the one off therapy of radiation, but research suggest tamoxifen performs better. can anyone share their personal experience with this? if you've taken tamoxifen- how were the side effects (i've read hot flashes & fatigue were the most notable)? if you've gone the radiation route, did it work?

[GP24]

Do both. The radiation is without side effects but it will work in less than 50% of the cases only. I also take tamoxifen, 10 or 20 mg and have no hot flashes or fatigue.

[MichaelDD]

I am a 15 year breast cancer survivor .. Stage 2 radical mastectomy I was on tamoxifen for 5 years after chemo. Cake walk to everything I'm doing now. Some hot flashes in the beginning and they tapered off.

[pwallace in reply to MichaelDD]

so sorry you've had to go through so much. thank you for sharing your experience.

[Tall_Allen]

In the randomized study below, 4 of 50 patients assigned bicalutamide and tamoxifen developed gynaecomastia, compared with 17 of 50 assigned bicalutamide and radiotherapy. So tamoxifen is four times as effective.

A single fraction of 12 Gy, compared to tamoxifen 10 mg daily, significantly increased the risk of suffering from nipple erythema and from skin irritation, but not

the risk for other adverse events.

thelancet.com/journals/lano...

I think it is prudent to get liver enzymes checked occasionally. Women with breast cancer have been taking it safely for many years.

[pwallace in reply to Tall_Allen]

yes looks like tamoxifen is the way to go, thanks for this.

[Tall_Allen in reply to pwallace]

fwiw - I'd be antsy getting low level radiation near the heart - who knows what the long-term effect of that is?

[MichaelDD in reply to Tall_Allen]

And men...

[Wassersug]

Although I respect greatly Tall Allen's knowledge about PCa and I know he supports the use of tamoxifen, I favour caution here. That is based on papers like:

[Tamoxifen induced thromboembolic events in breast cancer. Some possible mechanisms].

Latifyan S, Vansteelandt C, Lecomte S, Efira A.

Rev Med Brux. 2017;38(6):494-500. French

Tamoxifen Induced Pancreatitis: An Unusual Complication of Commonly used Drug.

Kataria PSC, Kendre PP, Patel AA, Bohra MZ, Tahitian N.

J Clin Diagn Res. 2017 Aug;11(8):XD05-XD06.

Aromatase inhibitor and tamoxifen use and the risk of venous thromboembolism in breast cancer survivors.

Xu X, Chlebowski RT, Shi J, Barac A, Haque R.

Breast Cancer Res Treat. 2019 Jan 18. doi: 10.1007/s10549-018-05086-8. [Epub ahead of print]

Correlation of the tamoxifen use with the increased risk of deep vein thrombosis and pulmonary embolism in elderly women with breast cancer: A case-control study.

Lin HF, Liao KF, Chang CM, Lin CL, Lai SW, Hsu CY.

Medicine (Baltimore). 2018 Dec;97(51):e12842

Based on such risks, though small, I personally would not take tamoxifen to block iatrogenic gynecomastia. Ironically that is despite having published data suggesting that it is probably safe (i.e., see:

Andrology. 2016 Sep;4(5):776-88. doi: 10.1111/andr.12197. Epub 2016 May 6.

Tamoxifen in men: a review of adverse events.

Wibowo E, Pollock PA, Hollis N, Wassersug RJ.

I would encourage anyone, who is anxious about iatrogenic gynecomastia, to consider what that side effects means to their identity. It is remarkable how variable men are about their bother from this side effect and their tolerance of gynecomastia. So, for example, I have talked to many men who didn't care about it at all. At the same time I have a medically qualified coauthor who had a mastectomy to reduce his iatrogenic gynecomastia secondary to ADT.

If one is interested in factors that may influence how bothersome men find gynecomastia, see:

The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management.

Wassersug RJ, Oliffe JL.

J Sex Med. 2009 Apr;6(4):989-1000.

Personally I had preemptive radiation, but I still got some gynecomastia. In retrospect, I share with Tall Allen the concern that my heart probably didn't need that radiation.

If anyone wants either of my papers mentioned above they can email me directly.

Richard W.

[jdayoc]

My radiation oncologist recommended radiation. When I asked my RP surgeon for his opinion, his nurse responded on his behalf telling me that radiation is what he would do. Radiation did not work for me. Breasts started to enlarge and nipples became VERY sensitive. After posing this problem to this community, that’s when I found out about Tamoxifen. Allen, in particular. So, I MADE my radiation oncologist prescribe Tamoxifen for me. Breasts stopped enlarging and nipple sensitivity disappeared. Go Tamoxifen! Joe

[jdayoc]

Oh...should have told you that I was prescribed Bicalutamide in preparation for radiation therapy due to biochemical recurrence. Joe

[CalBear74]

In 2012 when I was diagnosed, I was not offered either (residing in Phoenix in that period). I was on Bicalutamide for 3 years and 9 mos. Experienced slight enlargement. Since late 2016, I have been on Lupron only (I had been taking both). No medical issues were ever linked to the Bicalutamide. Good luck.

CalBear76

[Aodh]

I’ve opted (RO recommendation) for Tamoxifen 20mg daily. I’m on Casodex 50mg daily in addition to Zoladex injection every 12 weeks.

RO didn’t want to go with more radiation as I’m receiving 78 Gy over 8 weeks. As I believe that my recent fatigue is due to the daily radiation, I doubt that it’s related to the tamoxifen.

The only side effect that I have had (3 weeks in) is headaches though I have had that reaction to both Zoladex and Casodex too. The headaches either subside or I just get used to them after about 6 weeks!

The symptoms of gyneacomastia are already reducing.

Best wishes,

Hugh