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Two randomized trials demonstrated that prophylactic radiation therapy (RT) using 1\u202f\u00d7\u200910\u202fGy or 2\u202f\u00d7\u20096\u202fGy significantly reduced the rate of gynecomastia but not breast pain, as compared to observation. A\u00a0randomized dose-finding trial identified the daily dose of 20\u202fmg tamoxifen (TMX) as the most effective prophylactic dose and another randomized trial described that daily TMX use was superior to weekly use. Another randomized trial showed that prophylactic daily TMX is more effective than TMX given at the onset of gynecomastia. Two other randomized trials described that TMX was clearly superior to anastrozole in reducing the risk for gynecomastia and\/or breast pain. One comparative randomized trial between prophylactic RT using 1\u202f\u00d7\u200912\u202fGy and TMX concluded that prophylactic TMX is more effective compared to prophylactic RT and furthermore that TMX appears to be more effective to treat gynecomastia and\/or breast pain when symptoms are already present. A\u00a0meta-analysis confirmed that both prophylactic RT and TMX can reduce the risk of gynecomastia and\/or breast pain with TMX being more effective; however, the rate of side effects after TMX including dizziness and hot flushes might be higher than after RT and must be taken into account. Less is known regarding the comparative effectiveness of different radiation fractionation schedules and more modern RT techniques.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Prophylactic RT as well as daily TMX can significantly reduce the incidence of gynecomastia and\/or breast pain. TMX appears to be an effective alternative to RT also as a\u00a0therapeutic treatment in the presence of gynecomastia but its side effects and off-label use must be considered.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00066-020-01598-9","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T17:02:56Z","timestamp":1584032576000},"page":"589-597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Treatment strategies to prevent and reduce gynecomastia and\/or breast pain caused by antiandrogen therapy for prostate cancer"],"prefix":"10.1007","volume":"196","author":[{"name":"Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and The Working Party Radiation Oncology of the German Cancer Society (DKG-ARO)","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirus","family":"Ghadjar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Aebersold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Albrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"B\u00f6hmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Flentje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Ganswindt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"H\u00f6cht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"H\u00f6lscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt-Christian","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Niehoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pinkawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Sedlmayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Zips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wiegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"key":"1598_CR1","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/j.eururo.2014.07.010","volume":"67","author":"PL Nguyen","year":"2015","unstructured":"Nguyen\u00a0PL, Alibhai\u00a0SM, Basaria\u00a0S, D\u2019Amico\u00a0AV, Kantoff\u00a0PW, Keating\u00a0NL, Penson\u00a0DF, Rosario\u00a0DJ, Tombal\u00a0B, Smith\u00a0MR (2015) Adverse\u00a0effects\u00a0of\u00a0androgen\u00a0deprivation\u00a0therapy\u00a0 and\u00a0strategies\u00a0to\u00a0mitigate\u00a0them. 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