Anti-androgen therapy, a type of hormonal treatment, is frequently used in the treatment of advanced prostate cancer. It slows cancer growth and relieves symptoms in many men by lowering testosterone levels, but can cause a range of side effects due to hormonal disruption. For instance, anti-androgens can increase levels of estrogen, which stimulates the growth of breast tissue, leading to gynecomastia and breast pain.
In a systematic review published in BMC Medicine, Frank Kunath and colleagues from the German Cochrane Centre and University Clinic Erlangen assessed the benefits of tamoxifen for the treatment of breast events caused by anti-androgen therapy.
Tamoxifen is an anti-estrogen therapy commonly used in breast cancer treatment; recent studies have suggested that it can also be used as an alternative to surgery to treat gynecomastia in men. In their systematic review, Kunath and colleagues demonstrated that tamoxifen is effective for the treatment of breast events induced by anti-androgen therapy, when compared with radiotherapy or anastrozole.
Following on from this study, further clinical trials with long-term follow up should be designed to assess the side effects of tamoxifen treatment and determine the optimal dose. However, the results in this systematic review are a promising step forward.
Breast events occur in around 70% of patients undergoing anti-androgen therapy and cause many men to discontinue treatment. As demonstrated by Kunath and colleagues, tamoxifen is a potential therapeutic option for these distressing side effects, and could be used in conjunction with anti-androgen therapy. This should improve adherence to prostate cancer treatment, increasing survival and quality of life in these patients.