Stopping Eligard in Metastatic Prostate Cancer
An elderly man with metastatic prostate cancer should NOT stop Eligard (leuprolide) therapy, as androgen deprivation therapy must be continued indefinitely to maintain disease control and prevent rapid progression. 1
Core Principle: Continuous ADT is Standard of Care
Immediate continuous castration is the preferred treatment for metastatic hormone-naïve prostate cancer and should be maintained throughout the disease course. 1
Even when the disease progresses to castration-resistant prostate cancer (CRPC), castrate levels of testosterone must be maintained while additional therapies are applied. 1
The androgen receptor remains active even in castration-resistant disease, making continued testosterone suppression essential for any subsequent treatment to work effectively. 1
When ADT Should Continue
Leuprolide should be continued as long as:
- The patient is tolerating the medication without severe, life-limiting side effects 2
- Disease remains responsive in the majority of metastatic sites 2
- Disease-related symptoms remain controlled 2
- The patient has reasonable life expectancy where disease control matters for quality of life 1
Critical Pitfall to Avoid
Do not discontinue leuprolide based solely on PSA progression. 2 PSA rises alone do not indicate treatment failure if the patient remains clinically stable. The decision should be based on comprehensive clinical assessment including symptoms, imaging findings, and overall disease trajectory—not an arbitrary PSA threshold. 2
When Stopping Might Be Considered
The only scenarios where discontinuation is appropriate:
- Patient develops severe, intolerable side effects that significantly impair quality of life more than the cancer itself 1
- Patient has very limited life expectancy from other causes where ADT side effects outweigh any cancer control benefit 1
- Patient has documented global disease progression requiring complete change in systemic therapy approach, though even then ADT is typically maintained 1, 2
- Patient explicitly chooses comfort-focused care and accepts rapid disease progression 1
What Happens If Stopped
- Testosterone levels will recover within weeks to months 1
- Disease will progress rapidly in most cases, with potential for severe complications including pathologic fractures, spinal cord compression, and urinary obstruction 1
- Survival will be significantly shortened compared to continued therapy 1
Alternative to Complete Discontinuation
If the patient's concern is side effects or treatment burden, consider intermittent ADT instead of stopping entirely. 1 This allows treatment breaks while maintaining overall disease control, though it requires close monitoring of PSA and testosterone levels during off-treatment periods. 1 However, intermittent ADT is not recommended as standard for metastatic disease outside of significant intolerance to continuous therapy. 1
The Conversation to Have
Explore why the patient wants to stop:
- If side effects: Discuss specific symptom management strategies, consider intermittent therapy, or address individual symptoms (osteoporosis prevention, hot flash management, sexual dysfunction treatments) 1
- If treatment burden: Consider longer-acting formulations (6-month depot) to reduce injection frequency 3
- If goals of care have changed: Have honest discussion about prognosis with versus without treatment, and whether comfort-focused approach is more appropriate 4
The default answer remains: continue Eligard indefinitely for metastatic prostate cancer. 1