Breast Swelling and Tenderness (Gynecomastia)
What causes it: Some prostate cancer treatments, particularly anti-androgen pills (like bicalutamide) or other hormone therapies, can cause breast tissue growth in men. When testosterone is reduced or blocked, the balance of hormones can shift slightly toward estrogens (which males have in small amounts). This hormonal change can stimulate the breast glands. The result is gynecomastia, which means enlargement of male breast tissue, often accompanied by soreness or sensitivity. Not all hormone therapies cause this equally: it’s most common with anti-androgen monotherapy (for instance, many men taking bicalutamide for long durations experience some breast swelling). It’s less common with LHRH injections or after surgical castration, but it can still occur to a lesser extent. If you gain weight during hormone therapy, fat can also accumulate in the chest, making the breasts appear larger.
How it affects daily life: Breast enlargement in men can be physically uncomfortable and emotionally distressing. You might notice a small lump under one or both nipples, or a general increase in fatty tissue on your chest. The area can feel tender or painful, especially when pressed (for example, lying on your stomach might become uncomfortable). Some men feel self-conscious about the way their chest looks – you might avoid tight shirts or take steps to conceal your chest. Feelings of embarrassment or loss of masculinity are not uncommon. The tenderness can also make activities like running or even descending stairs (due to the mild jarring movement) slightly painful unless you wear supportive undergarments. In extreme cases, men can develop quite noticeable breasts. It’s important to know that this is a recognized side effect of treatment; talking to your doctor about it is absolutely fine and they may have ways to help.
Ways to manage or reduce it: There are a few approaches to dealing with gynecomastia from prostate cancer treatment. Prevention: If you are about to start long-term anti-androgen therapy, discuss preventive measures with your doctor. One proven method is a single low-dose radiation treatment to the breasts shortly after starting therapy. This prophylactic radiotherapy can reduce the development of breast tissue by affecting the breast glands, and it’s most effective if done within the first month of hormone treatment. (The radiation dose is low and has minimal side effects – possibly some temporary skin redness.) Another preventive approach is taking a medication like tamoxifen, which is actually a breast cancer drug that blocks estrogen in breast tissue. Tamoxifen can significantly reduce breast swelling in men on anti-androgens. It’s often used if radiation was not given or wasn’t fully effective. If you already have breast enlargement and it’s bothersome, tamoxifen can also be used after the fact to reduce pain and possibly shrink the tissue. It may take a few months to see an effect.
Lifestyle management: If weight gain is contributing, adopting a healthy diet and regular exercise may help reduce fat in the chest area. Even though hormone therapy can make weight loss challenging, any gradual loss of excess weight might lessen the breast size. Wearing a snug-fitting sports bra or compression vest designed for gynecomastia can support the chest and reduce discomfort during activity – some men find this helpful (though others may dislike the idea of wearing what is essentially a bra). Surgery: For severe cases that don’t respond to other measures, surgical removal of the breast tissue is an option. This is usually considered only if the pain or emotional impact is significant, since surgery carries its own risks (such as scarring or loss of nipple sensation). In most cases, breast swelling from hormone therapy will remain as long as you’re on treatment, but knowing that there are ways to manage it can ease your mind. Talk to your doctor if breast tenderness or enlargement occurs; they may check to ensure it’s indeed treatment-related and not another condition, and then help you with the above strategies.