RT Journal Article
SR Electronic
T1 Male Breast Adenocarcinoma in a Prostate Cancer Patient Following Prolonged Anti-androgen Monotherapy
JF Anticancer Research
JO Anticancer Res
FD International Institute of Anticancer Research
SP 1077
OP 1082
VO 24
IS 2C
A1 KARAMANAKOS, PETER
A1 MITSIADES, CONSTANTINE S.
A1 LEMBESSIS, PETER
A1 KONTOS, MICHAEL
A1 TRAFALIS, DEMETRIOS
A1 KOUTSILIERIS, MICHAEL
YR 2004
UL http://ar.iiarjournals.org/content/24/2C/1077.abstract
AB We report the case of an 82-year-old male patient with a > 8-year history of prostate cancer (PrCa), who developed breast adenocarcinoma (BrCa) (Ki-67+ and negative for ER, PR, PSA and HER2/neu) after prolonged (~7-year) anti-androgen (flutamide) monotherapy for locally advanced PrCa. Biochemical and molecular analyses showed hyperestrogenemia (serum estradiol = 266 pg/ml, with normal range < 74 pg/ml), germline BRCA-1 mutation (T to C at nucleotide 3232, in exon 11, causing Glu to Gly change at codon 1038) and chromosome 9 inversion (karyotype of 46,XY with inv(9) (p11q21)). Following bilateral mastectomy without adjuvant systemic therapy, the patient has been disease-free (from both BrCa and PrCa) for > 3 years. In contrast to LHRH-based hormonal therapies for PrCa, anti-androgen monotherapy causes hyper-estrogenemia due to the suppressed negative feedback loop of androgens on LHRH and LH production, stimulation of testicular androgen production and their intracrine transformation to estrogens in peripheral target tissues. In this case report, the hyperestrogenemia may have further increased the BrCa risk in a patient with other risk factors (BRCA-1 mutation and chromosome 9 inversion, which has been previously shown to impinge upon testicular function and intracrine balance of androgens vs. estrogens). This case report illustrates that PrCa patients receiving anti-androgen monotherapy may be at risk of BrCa, in the event of the concomitant presence of other genetically-determined predisposing factors, and indicates the importance of exercising caution against indiscriminate and prolonged use of anti-androgen monotherapy in patients with risk factors for male BrCa. Copyright© 2004 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved