Optimal Control of Testosterone: A Clinical Case-Based Approach of Modern Androgen-Deprivation Therapy

ObjectivesTestosterone control is an important issue in patients treated with androgen-deprivation therapy (ADT) for prostate cancer (PCa). Available data on this topic are reviewed with emphasis on the luteinising hormone-releasing hormone (LHRH) agonist Eligard®.MethodsThis paper is based on a presentation at the New Horizons in Urology meeting in 2007.ResultsLHRH agonist treatment is a deprivation therapy. The administered compound is not toxic to the cells by itself, but blocks the production of testosterone. The appropriate time and duration of the treatment in different clinical settings is still under discussion. LHRH agonists using currently available delivery systems do not achieve and maintain castration testosterone levels in up to 37% of the patients. With Eligard 1-, 3-, and 6-mo formulations the majority of patients have a testosterone level ≤20 ng/dl. Breakthrough testosterone escapes and mini-flares are rarely observed. The 6-mo formulation of Eligard decreases the number of injections, so patients need to visit their doctors less frequently and are less reminded of their disease.ConclusionsEligard 1-, 3-, and 6-mo depot formulations provide optimal testosterone control. Eligard 6 offers more convenience and reduces emotional distress.