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Profylactische tepelbestraling bij bicalutamidegebruik vanwege prostaatkanker: klinische noodzaak?


Gynaecomastie en pijn in de tepels (mastalgie) zijn frequent voorkomende bijwerkingen van bicalutamide 150 mg monotherapie. Profylactische tepelbestraling wordt in veel ziekenhuizen in Nederland toegepast. De door bicalutamide veroorzaakte gynaecomastie wordt vaak als mild ervaren en de mastalgie is meestal van voorbijgaande aard. Hoewel uit meerdere gerandomiseerde studies een statistisch significante afname van de frequentie van deze bijwerkingen blijkt, persisteert in de helft van de gevallen de gynaecomastie/mastalgie. Derhalve bestaat er twijfel over de effectiviteit en de klinische noodzaak tot profylactische tepelbestraling.

Het anti-oestrogeen tamoxifen heeft een zeer hoge effectiviteit bij de preventie en behandeling van door bicalutamide veroorzaakte gynaecomastie/mastalgie. Bij patiënten die onder bicalutamide monotherapie uiteindelijk toch cosmetische bezwaren aangeven van hun gynaecomastie en/of bezwaarlijke mastalgie ervaren, kan gestart worden met het anti-oestrogeen tamoxifen. Momenteel zijn er geen aanwijzingen dat het medicament een negatieve invloed heeft op het oncologisch beloop van prostaatkanker.


Profylactic radiotherapy of the nipple buds for bicalutamide use. Any Clinical value?

Gynaecomasthia and breast pain (masthalgia) are frequently noticed side effects of bicalutamide 150 mg monotherapy. Prophylactic radiotherapy of the nipplebuds is applied in many hospitals in the Netherlands. Gynaecomasthia caused by bicalutamide is mostly experienced as mild, and the masthalghia is mostly self limiting. Despite the finding that several randomised clinical trials showed a statistically significant decrease in the relative amount of side effects, in half of the cases the gynaemasthia and/or masthalgia persists. Therefore, concerns exist over the effectivity and clinical need of prophylactic radiation of the nipple buds.

The anti-estrogen drug tamoxifen has high effectivity in the prevention and treatment of gynaecomasthia/masthalgia caused by bicalutamide. In those patients on bicalutamide monotherapy who experience cosmetic complaints of their gynaecomasthia and/or suffer from masthalgia, tamoxifen may be prescibed. At present, there is no evidence that tamoxifen has a negative impact on the oncological outcome of prostate cancer.

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Correspondence to A.N. Vis.

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* dr. A.N. Vis, uroloog, afdeling Urologie, Vrije Universiteit Medisch Centrum, Amsterdam

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Vis, A. Profylactische tepelbestraling bij bicalutamidegebruik vanwege prostaatkanker: klinische noodzaak?. Tijdschrift voor Urologie 4, 13–17 (2014).

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  • prostaatkanker
  • bicalutamide
  • tepelbestraling
  • gynaecomastie
  • mastalgie
  • tamoxifen


  • prostate cancer
  • bicalutamide
  • radiation therapy nipple
  • gynaecomasthia
  • masthalgia
  • tamoxifen