Abstract
ObjectivesTo investigate the levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prostate-specific antigen (PSA) in prostate cancer patients before and after the switch from degarelix to leuprolide treatments.MethodsWe enrolled 40 treatment-naïve prostate cancer patients who were treated initially with degarelix and were later switched to leuprolide. The subjects were divided into three groups depending on when they were switched to leuprolide: the 3-month group (3m; switched after 84 days, n=10), the 2-month group (2m; 56 days, n=10), and the 1-month group (1m; 28 days, n=20). Patient symptoms and hormone levels were measured after switching therapy. The castration level was defined as a serum testosterone level ≤50 ng/dl.ResultsThirty-nine subjects (97.5%) achieved castration levels of testosterone (11±5.8 ng/dl) 2 weeks after degarelix was first administered, and the characteristics of these patients were investigated. Testosterone levels increased and exceeded the castration level in one subject each of the 3m (142 ng/dl), 2m (72 ng/dl), and 1m groups (63 ng/dl). All subjects achieved the castration level by day 5. In contrast to testosterone levels, the LH and FSH surge on day 2 was significantly higher in the 1m group than in the other groups. The clinical symptoms were not exacerbated before or after switching in any patients.ConclusionsA testosterone surge was observed in 8.3 % of the study patients; however, it was very short-lived and mild. LH and FSH levels were significantly higher 1 month after administration compared with 2 or 3 months after degarelix administration.
Highlights
Prostate cancer is the most common cancer in males in Western countries, and its incidence has increased in Japan [1]
The primary objective of the study was to evaluate the surge in testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prostate-specific antigen (PSA) and to determine whether symptoms worsened during the switch from degarelix to leuprolide
Testosterone determined by electrochemiluminescence Immunoassay (ECLIA) The mean testosterone level before initiating androgen deprivation therapy (ADT) using degarelix was 470.4 ± 161.1 ng/dl
Summary
Prostate cancer is the most common cancer in males in Western countries, and its incidence has increased in Japan [1]. Luteinizing hormonereleasing hormone (LHRH) agonists are the most prevalent form of ADT. The main concern with the use of LHRH agonists for ADT is the clinical worsening of. Degarelix, the GnRH antagonist currently available in Japan, has therapeutic effects that last for only 1 month, and patients must commute to the hospital once a month to Miyazawa et al Basic and Clinical Andrology (2015) 25:7 receive subcutaneous injections. The LHRH agonists leuprolide and goselerin are available as 1 and 3 month formulations, respectively. The interval between hospital visits using 3-month formulations helps reduce the number of hospital visits, as well as the number of subcutaneous injections. When ADT treatment is initiated, patients are often switched to a LHRH agonist empirically after the state of castration is reached using degarelix, thereby precluding the need for an antiandrogen. The patients gain the benefit of longer intervals between hospital visits
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