Luteinizing hormone-releasing hormone monotherapy: a viable option for treatment of prostate cancer?
When addressing the appropriateness of luteinizing hormone-releasing hormone (LHRH) analog monotherapy as a method of androgen deprivation, it is important to look at the alternative option of androgen deprivation by combined androgen blockade (CAB). The randomized control trials studying CAB have been thoroughly analyzed and subjected to meta-analyses that have shown a small but significant difference in survival at 5 years. These findings have been subject to variable interpretations. Much like other treatment-option decisions for prostate cancer, it is mandatory to inform patients fully on the costs and benefits of monotherapy versus CAB and to incorporate the patient's concerns and preferences in the decision-making process. Currently, parameters to identify a subgroup of patients who might specifically benefit from a combined androgen deprivation treatment policy are not available. When using monotherapy, it is necessary to recognize several important facts. Castrate testosterone levels are not achieved or maintained in all patients. For some patients this may be a disadvantage. Additionally, before categorizing a patient as having an androgen-independent tumor, it is important to measure serum testosterone to ensure that LHRH analog monotherapy has achieved and maintained a castrate testosterone level.
Schellhammer
P F
PF
Department of Urology, Virginia Prostate Center of the Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. Pfs@borg.evms.edu
D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D011944:Receptors, Androgen / Q000502:physiology; D013739:Testosterone / Q000097:blood / Q000502:physiology; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D011944:Receptors, Androgen; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone