Management practices in advanced prostate cancer - options in long-term luteinising-hormone-releasing hormone therapy

Testosterone suppression through orchidectomy is a gold-standard treatment for patients presenting with advanced prostate cancer. However, this can have a physical and psychological toll on patients, leaving many preferring androgen-deprivation therapy. To this end, luteinisinghormone-releasing hormone (LHRH) agonists are commonly used to achieve castrate levels of testosterone, with efficacy being comparable to that of orchidectomy. Although historically limited by short half-lives, scientific progress has led to increased potency of LHRH agonists through prolonged half-lives. Newer advances include the subcutaneous implantation device, which allows for constant release of histrelin acetate over 52 weeks, conferring advantages over previous therapies and necessitating repeat injections every one to six months. Suppression of testosterone levels to castrate levels has been shown to be comparable to orchidectomy at four weeks, and is safe and well-tolerated. Moreover, removal of the implant allows for rapid normalisation of testosterone levels. The conveniences associated with implantation compared with depot injections confer increased treatment flexibility to both patients and healthcare professionals.4 page(s