Abstract
We appreciate the thoughtful Editorial Comment on our manuscript “The Effect of Baseline Testosterone on the Efficacy of Degarelix and Leuprolide: Further Insights from a 12-Month, Comparative, Phase III Study in Prostate Cancer Patients.” We agree that testosterone levels required after gonadotropin-releasing hormone (GnRH) manipulation merit reevaluation, especially with the availability of improved measurement techniques. Although there is currently a lack of consensus on the optimum suppressed testosterone level in prostate cancer (PCa), a 0.2 ng/mL threshold has been recommended after androgen deprivation therapy (ADT) in advanced disease. 1 Djavan B. Eastham J. Gomella L. et al. Testosterone in prostate cancer: the Bethesda consensus. BJU Int. 2011; (In press) Google Scholar Editorial CommentUrologyVol. 80Issue 1PreviewAlthough 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. Full-Text PDF
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