From the Guidelines
LHRH agonists for carcinoma of the prostate are not stopped, even when the cancer becomes castration-resistant, as they should be continued to maintain castrate serum levels of testosterone (<50 ng/dL) 1. When considering the management of prostate cancer, it's essential to understand the role of LHRH agonists in maintaining castrate levels of testosterone. According to the latest guidelines 1, LHRH agonists should be continued in patients with castration-resistant prostate cancer (CRPC) to maintain castrate serum levels of testosterone (<50 ng/dL). Some key points to consider when managing CRPC include:
- Monitoring PSA doubling time (PSADT) to determine the frequency of imaging and the need for secondary hormone therapy 1
- Considering metastatic lesion biopsy, microsatellite instability (MSI)/mismatch repair (MMR) testing, and germline and tumor testing for mutations in homologous recombination repair (HRR) genes 1
- Continuing ADT while sequentially applying additional therapies, including secondary hormone therapies, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies 1 It's crucial to prioritize the patient's quality of life and overall treatment goals when making decisions about LHRH agonist therapy 1.
From the Research
LHRH Agonists in Prostate Cancer Treatment
Luteinizing Hormone-Releasing Hormone (LHRH) agonists are commonly prescribed for the treatment of carcinoma (ca) of the prostate. The decision to stop LHRH agonists is typically based on various factors, including:
- Disease progression or recurrence [ 2, 3, 4 ]
- Adverse effects, such as osteoporosis, hot flushes, and cognitive impairment [ 2, 3, 5 ]
- Patient preference or quality of life concerns [ 6 ]
Alternatives to LHRH Agonists
In some cases, alternative treatments may be considered, such as:
- Orchiectomy [ 3 ]
- Estrogen therapy [ 2 ]
- Next-generation hormonal agents, such as abiraterone and enzalutamide [ 4 ]
Timing of LHRH Agonist Discontinuation
The timing of LHRH agonist discontinuation depends on individual patient factors, including: