Info
Androgen deprivation therapy
Initial systemic therapy for men w/ advanced prostate CA to suppress testosterone
- GnRH agonists:
- Eg, leuprolide. Binds to GnRH receptor in pituitary to cause initial LH & FSH release then → fall w/in 3-4 wks. Given w/ antiandrogen, eg, bicalutamide, for at ↣ least 7 d to prevent flare related to initial testosterone surge (Figure 14-1)
- GnRH antagonist:
- Eg, degarelix. Pure GnRH antagonist-does not cause LH/FSH release. Testosterone suppressed w/in 3 d
- Bilateral orchiectomy:
- Uncommon in the United States
- Can normalize PSA in >90% & cause tumor response in >80%, palliate bone pain & reduce complications 2° to prostate CA. Duration of response is → variable
- S/E: Hot flashes, osteoporosis, fracture, obesity, diabetes, hyperlipidemia, coronary artery dz, decr libido, mood lability, possible cognitive impairment. Increase w/ duration of tx