Abstract
Although generally effective in suppressing serum androgens, gonadotropin-releasing hormone (GnRH) agonists have several liabilities that have motivated the development of alternatives. Before reducing testosterone, GnRH agonists such as leuprolide initially produce a surge in luteinizing hormone (LH), which consequently induces a transient rise in serum testosterone, an event that can result in worsening tumor-related symptoms termed a clinical flare in men with metastatic disease. Microsurges in testosterone commonly occur with repeat GnRH agonist dosing, and breakthrough rises in serum testosterone exceeding castrate levels during treatment occur in up to 13% of men.
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