ABSTRACT
PURPOSE: We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by 150 mg bicalutamide in a prospective, randomized, multi-institutional trial. MATERIALS AND METHODS: After definitive treatment for localized prostate cancer 125 patients were randomized to 12 Gy radiotherapy before bicalutamide as prophylactic radiotherapy (53) or bicalutamide only for nonprophylactic radiotherapy (72). The incidence of gynecomastia, breast pain and tenderness, and discomfort perceived by the patients was assessed by physical examination and direct questioning at 3, 6 and 12 months of followup. RESULTS: At the end of 12 months the gynecomastia rate was 15.8% in the prophylactic group and 50.8% in the nonprophylactic group (p <0.001). On patient evaluation the breast enlargement rate was 34.4%. The severity of breast pain and tenderness was not different between the groups. The breast pain rate was 36.4% and 49.2% by 12 months in the prophylactic and nonprophylactic groups, and the rate of patients who felt discomfort from gynecomastia was 11.4% and 29.5%, respectively. CONCLUSIONS: In this prospective study the incidence of gynecomastia was not as high as previously believed. Although prophylactic breast irradiation seemed to decrease the gynecomastia rate in patients on 150 mg bicalutamide, our study proves that not all patients need prophylaxis since only 52% were significantly bothered by gynecomastia. Thus, individual assessment is needed to select patients who need prophylactic radiation while on 150 mg bicalutamide.
Subject(s)
Anilides/adverse effects , Antineoplastic Agents/adverse effects , Breast Neoplasms, Male/prevention & control , Breast Neoplasms, Male/radiotherapy , Gynecomastia/chemically induced , Nitriles/adverse effects , Pain/chemically induced , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/pathology , Tosyl Compounds/adverse effects , Aged , Breast Neoplasms, Male/secondary , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To study prospectively experimental effects of unilateral epididymal obstruction on testis and epididymis histopathologically in prepubertal rats. STUDY DESIGN: Organ weights, mean seminiferous tubule diameter (MSTD), mean ductus epididymis diameter (MDED), mean tubular biopsy scores (MTBS) and histopathology of 21 male albino Wistar rats were compared with the immunostaining affinity of anti-desmin, anti-vimentin, anti-laminin and anti-collagen antibodies. RESULTS: Statistical analysis of mean weight of testes, MTBS, mean epididymal weight, MDED and MSTD was significant. Evaluation of testis and epididymis revealed cellular damage, basal membrane impairment and granulomatous infiltration. CONCLUSION: Histopathologic alterations with MSTD are early indicators for ipsilateral and contralateral injury. Even the presence of criteria such as intactness and cellular integrity does not guarantee there is no sperm leakage or immunologic damage. Therefore the impairment of basal integrity is a switch code in determining spermatogenic failure.
