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and increased hydrolysis of MTXPGs by lysosomal gamma-glutamyl hydrolases (GGH) (2325), although the influence of GGH on MTX efficacy remains controversial (2628)

This is one reason injections may be discussed for men whose erections have changed after prostate surgery, radiation, or hormone therapy

Timing optimization also reduces side effects

Distant metastasis and progression: Breast cancer metastasis is a complex, multicellular, and highly regulated process involving local invasion of primary tumor cells, epithelial-to-mesenchymal transition, invasion into the bloodstream, survival of tumor cells in the circulatory system, and colonization of secondary distant sites