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RT to prevent enlarged breasts

User
Posted 10 Nov 2023 at 01:52

Has anyone had experience with RT to help prevent enlarged breasts from HT and is this problem a real issue anyway? 

User
Posted 10 Nov 2023 at 07:58

There are two types of breast enlargement from hormone therapy (and no, they're not left, and right;-)

Men have the same breast buds that women had before puberty, but because they are exposed to more testosterone than estrogens in men, they don't grow into breast glands. The hormone therapy can mess with this and result in the breast buds seeing more estrogen than testosterone, and that can cause the glands to start growing. This is a condition called gynecomastia in men, and it is often accompanied by breast gland sensitivity/pain called mastodynia. Indeed, the mastodynia is often noticed first.

The other form of breast enlargement is breast fat development. Again, this is normally prevented by testosterone, but in the absence of testosterone, the body can redistribute fat in a female form which includes laying down more fat on the breasts. This is sometimes called pseudogynecomastia. There is no mastodynia in this case.

gynecomastia and mastodynia are more common in men who are only on Bicalutamide as their hormone therapy, and pseudogynecomastia is more common in men on hormone therapy injections (with or without Bicalutamide). However, they can both happen in both cases. Some men also report a brief spell of gynecomastia and mastodynia when their testosterone returns after finishing hormone therapy injections - the cause of this is unknown but is probably the same as can happen in some boys starting puberty.

A single (or occasionally double) radiotherapy blast to the breast buds aims to destroy the ability of the breast buds to grow. It is often said this would need to be given before any breast bud growth had started. Some research shows this treatment has around a 50% success rate. It does come with a little risk of causing secondary breast cancer in the future, and also of causing minor damage the heart muscle (many cases are incidental findings when looking for something else, but are not causing any significant side effects). When this treatment works, it prevents subsequent gynecomastia, but it has no impact on pseudogynecomastia. Not all centres do this treatment, and in practice it often can't happen because urology start you on hormone therapy before you get to see oncology, by which time it's probably too late to have the treatment.

Another treatment to prevent gynecomastia and mastodynia, much more popular, and around 70% effective is the drug Tamoxifen. This is a selective estrogen blocker, and stops breast tissue from being able to see estrogens, so it's more commonly used as part of the treatment of hormone sensitive breast cancer. For men on Bicalutamide alone for longer than 2 months, it's sometimes prescribed with the Bicalutamide at the rate of 1 x 20mg/week. Alternatively, it can be added later when gynecomastia or mastodynia is experienced although a higher dose is likely to be required at least initially because it takes around 3-4 weeks to build up the working level in your system. It's often said you have to start Tamoxifen before gynecomastia starts but this isn't true, although it may be preferable to avoid needing a higher dose later. Tamoxifen can reverse very recent breast gland growth (again probably needing a higher dose), but not anything which is long-standing, although it would still help to prevent any additional growth. Tamoxifen has no impact on pseudogynecomastia.

Tamoxifen can be liver-toxic in some people, although this is more of an issue for higher doses used as part of breast cancer treatment, but you should get a liver function test done after 3-4 months on Tamoxifen, and then perhaps 6 or 12-monthly after that. Tamoxifen won't be available if you have any history or risk for DVT or heart attack, and it does have a DVT risk of its own.

The only preventative treatment for pseudogynecomastia is to avoid putting on excess fat through careful dieting.

User
Posted 10 Nov 2023 at 09:00

Originally Posted by: Online Community Member
I did read that guys who carry alot of fat around the waist were more likely to grow boobs

Fat contains an enzyme Aromatase which converts Testosterone into Estrogens, so men with lots of fat have a higher Estrogen and lower Testostrone level, and this in turn causes more fat to be laid down, particularly in a female form.

User
Posted 10 Nov 2023 at 14:54
I had breast enlargement despite being on Tamoxifen (I was on bicalutimide as a primary HT), and my oncologist suggested breast-bud RT to stop it. It was done on a different machine to the prostate RT machine because it's lower-energy radiation. I went in for one session in which they drew a circle around each side of my chest in permanent marker, and made a custom-fitted lead shield to protect other parts of my chest. I then went in for two treatment session, with one side being "zapped" in each session. I came out in a bright-red saucer-size circle on each side of my chest, like severe sunburn, which took several weeks to fade, but it stopped the breast pain and growth dead in its tracks.

Chris

User
Posted 10 Nov 2023 at 15:46

Thanks Chris, well yes I do carry a bit of weight around the gut. weight is 95KGs 178cm high and so if I can get sub 90's in the next month before I start the HT, it may serve me well. I must see if anyone has a sensible and doable exercise routine suitable for a 65yo to try and do while on HT as I keep hearing about the important need to exercise while on HT. I'm a bit like you, not a great lover of exercise, but this PCa stuff may shake me out of that way of life and into being a little more concerned about my fitness level. 

Thanks again and all the best.

User
Posted 10 Nov 2023 at 22:32

Originally Posted by: Online Community Member

Thanks Chris, well yes I do carry a bit of weight around the gut. weight is 95KGs 178cm high and so if I can get sub 90's in the next month before I start the HT, it may serve me well. I must see if anyone has a sensible and doable exercise routine suitable for a 65yo to try and do while on HT as I keep hearing about the important need to exercise while on HT. I'm a bit like you, not a great lover of exercise, but this PCa stuff may shake me out of that way of life and into being a little more concerned about my fitness level. 

Thanks again and all the best.

For exercise I would recommend walking, swimming, cycling, and if you don’t like going to the gym buy yourself some resistance bands. I’m amazed at just how many different muscle strengthening exercise you can achieve with them and they are very cheap to buy. 
Im sorry to say though that you can exercise as much as you like but unless you have a healthy diet you will find it difficult to lose weight. Since starting HT I just need to LOOK at food and I put on weight. I take Herbalife Protein shakes which helps me keep my weight in check.

All the best with your treatment.

Derek

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User
Posted 10 Nov 2023 at 07:58

There are two types of breast enlargement from hormone therapy (and no, they're not left, and right;-)

Men have the same breast buds that women had before puberty, but because they are exposed to more testosterone than estrogens in men, they don't grow into breast glands. The hormone therapy can mess with this and result in the breast buds seeing more estrogen than testosterone, and that can cause the glands to start growing. This is a condition called gynecomastia in men, and it is often accompanied by breast gland sensitivity/pain called mastodynia. Indeed, the mastodynia is often noticed first.

The other form of breast enlargement is breast fat development. Again, this is normally prevented by testosterone, but in the absence of testosterone, the body can redistribute fat in a female form which includes laying down more fat on the breasts. This is sometimes called pseudogynecomastia. There is no mastodynia in this case.

gynecomastia and mastodynia are more common in men who are only on Bicalutamide as their hormone therapy, and pseudogynecomastia is more common in men on hormone therapy injections (with or without Bicalutamide). However, they can both happen in both cases. Some men also report a brief spell of gynecomastia and mastodynia when their testosterone returns after finishing hormone therapy injections - the cause of this is unknown but is probably the same as can happen in some boys starting puberty.

A single (or occasionally double) radiotherapy blast to the breast buds aims to destroy the ability of the breast buds to grow. It is often said this would need to be given before any breast bud growth had started. Some research shows this treatment has around a 50% success rate. It does come with a little risk of causing secondary breast cancer in the future, and also of causing minor damage the heart muscle (many cases are incidental findings when looking for something else, but are not causing any significant side effects). When this treatment works, it prevents subsequent gynecomastia, but it has no impact on pseudogynecomastia. Not all centres do this treatment, and in practice it often can't happen because urology start you on hormone therapy before you get to see oncology, by which time it's probably too late to have the treatment.

Another treatment to prevent gynecomastia and mastodynia, much more popular, and around 70% effective is the drug Tamoxifen. This is a selective estrogen blocker, and stops breast tissue from being able to see estrogens, so it's more commonly used as part of the treatment of hormone sensitive breast cancer. For men on Bicalutamide alone for longer than 2 months, it's sometimes prescribed with the Bicalutamide at the rate of 1 x 20mg/week. Alternatively, it can be added later when gynecomastia or mastodynia is experienced although a higher dose is likely to be required at least initially because it takes around 3-4 weeks to build up the working level in your system. It's often said you have to start Tamoxifen before gynecomastia starts but this isn't true, although it may be preferable to avoid needing a higher dose later. Tamoxifen can reverse very recent breast gland growth (again probably needing a higher dose), but not anything which is long-standing, although it would still help to prevent any additional growth. Tamoxifen has no impact on pseudogynecomastia.

Tamoxifen can be liver-toxic in some people, although this is more of an issue for higher doses used as part of breast cancer treatment, but you should get a liver function test done after 3-4 months on Tamoxifen, and then perhaps 6 or 12-monthly after that. Tamoxifen won't be available if you have any history or risk for DVT or heart attack, and it does have a DVT risk of its own.

The only preventative treatment for pseudogynecomastia is to avoid putting on excess fat through careful dieting.

User
Posted 10 Nov 2023 at 08:07

MS58, I am 5 days from completing six months of 150mg daily bicalutamide. My oncologist seems to be at odds with his peers. He dismissed any suggestion of tamoxifen, not sure what he said about RT but I haven't had any to the breasts. My nipples are tender and little lumpy. There has been a slight increase in the breasts but nothing major. So I have been lucky to get away without man boobs. 

I did read that guys who carry alot of fat around the waist were more likely to grow boobs, I have a reasonable beer belly but seem to seemed to have dodged the boobs. I have cut out the cookies and granola squares, perhaps that helped. I am a bit of a couch potato when it comes to exercise.

Hope all goes well for you.

Thanks Chris 

User
Posted 10 Nov 2023 at 09:00

Originally Posted by: Online Community Member
I did read that guys who carry alot of fat around the waist were more likely to grow boobs

Fat contains an enzyme Aromatase which converts Testosterone into Estrogens, so men with lots of fat have a higher Estrogen and lower Testostrone level, and this in turn causes more fat to be laid down, particularly in a female form.

User
Posted 10 Nov 2023 at 14:54
I had breast enlargement despite being on Tamoxifen (I was on bicalutimide as a primary HT), and my oncologist suggested breast-bud RT to stop it. It was done on a different machine to the prostate RT machine because it's lower-energy radiation. I went in for one session in which they drew a circle around each side of my chest in permanent marker, and made a custom-fitted lead shield to protect other parts of my chest. I then went in for two treatment session, with one side being "zapped" in each session. I came out in a bright-red saucer-size circle on each side of my chest, like severe sunburn, which took several weeks to fade, but it stopped the breast pain and growth dead in its tracks.

Chris

User
Posted 10 Nov 2023 at 15:37

Hi Andy,

Wow, thanks for such a comprehensive answer. I appreciate your time in providing us with such detail. I do recall asking you in a previous question about your journey so far (which I have read) and if I recall, you were having some slight rectal bleeding issues, which I assume was from the RT. I was asking at that time, as to why you didn't use Barrier Gel and knowing what you know now, would you have used it? 

My Aussie RO said that the newer Barrier Gel is far superior than the SpaceOAR and they now strongly recommend using it despite the very low risk of it trapping some potential PCa cells that may be attached to the rectal wall and out of reach of the RT. 

Any thoughts? 

Oh and by the way, thanks for everything you are doing for the PCa fraternity. You and a guy in the USA on healthunlocked called Tall_Allan (not sure if you know of him) deserve medals! 

User
Posted 10 Nov 2023 at 15:40

Thanks Chris. So you are a success story as far as RT on the breasts are concerned. I will definitely raise this with my RO prior to commencing HT next month. Thanks again.

User
Posted 10 Nov 2023 at 15:46

Thanks Chris, well yes I do carry a bit of weight around the gut. weight is 95KGs 178cm high and so if I can get sub 90's in the next month before I start the HT, it may serve me well. I must see if anyone has a sensible and doable exercise routine suitable for a 65yo to try and do while on HT as I keep hearing about the important need to exercise while on HT. I'm a bit like you, not a great lover of exercise, but this PCa stuff may shake me out of that way of life and into being a little more concerned about my fitness level. 

Thanks again and all the best.

User
Posted 10 Nov 2023 at 22:32

Originally Posted by: Online Community Member

Thanks Chris, well yes I do carry a bit of weight around the gut. weight is 95KGs 178cm high and so if I can get sub 90's in the next month before I start the HT, it may serve me well. I must see if anyone has a sensible and doable exercise routine suitable for a 65yo to try and do while on HT as I keep hearing about the important need to exercise while on HT. I'm a bit like you, not a great lover of exercise, but this PCa stuff may shake me out of that way of life and into being a little more concerned about my fitness level. 

Thanks again and all the best.

For exercise I would recommend walking, swimming, cycling, and if you don’t like going to the gym buy yourself some resistance bands. I’m amazed at just how many different muscle strengthening exercise you can achieve with them and they are very cheap to buy. 
Im sorry to say though that you can exercise as much as you like but unless you have a healthy diet you will find it difficult to lose weight. Since starting HT I just need to LOOK at food and I put on weight. I take Herbalife Protein shakes which helps me keep my weight in check.

All the best with your treatment.

Derek

User
Posted 10 Nov 2023 at 23:41

Thanks Derek, It is going to be hard moving across to Rabbit Food while on HT. From my understanding good old-fashioned medium rare steaks are not good for PCa, whereas vegetables like brussel sprouts and brocoli are good. 😩 I hope that grilled Atlantic Salmon will still be good to eat. In fact, has anybody put out a good diet with plenty of variety foods that will assist PCa sufferers that are on HT? Please don't go telling me that red wine is a no no !!!! 

Edited by member 10 Nov 2023 at 23:42  | Reason: Not specified

User
Posted 12 Nov 2023 at 07:48

I had to increase my ratio of protein, in order to avoid losing too much muscle while exercising. Not being much of a red meat eater in the first place, this was mostly chicken and salmon. (I had discovered 10+ years before that salmon stopped my joint pain, and fortunately I rather like it.)

During radiotherapy, I had to switch to a fibre-free diet, and slowly returned to normal over the following 5 months, although broccoli took longer.

Exercise is important, but so is watching your calorie intake - a small amount of excess food takes an awful lot of exercise to compensate.

 
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