Role of Luteinising Hormone Releasing Hormone (LHRH) Agonists and Hormonal Treatment in the Management of Prostate Cancer

Abstract

The use of luteinising hormone releasing hormone (LHRH) agonists has increasingly evolved during the past 10 years. This review paper aims to discuss the role of LHRH agonists in patients with prostate cancer, a leading cause of cancer death in men. To retrieve the most relevant randomised clinical trials (RCTs), a Medline search was performed in the last quarter of 2004. Only fully published studies in English language with at least 25 patients per treatment arm and those frequently cited in review articles were included in the current review. This review does not claim to have included every single study with the selected treatment options, but aimed at including the most important trials performed and fully published with these treatments. The retrieved studies are discussed and put into perspective of the EAU guidelines. Initially, LHRH agonists were part of the treatment strategy for patients with advanced or metastatic disease. Currently, LHRH agonists are increasingly used as a treatment option in a neoadjuvant and/or adjuvant setting for patients with early or localised disease. LHRH analogues are used as adjuvant hormonal therapy after radical prostatectomy, and as neoadjuvant and adjuvant treatment to radiotherapy. Patients with early or localised disease and a low Gleason score may experience clinical benefit from the neoadjuvant addition of LHRH agonists to radiotherapy. In patients with a high Gleason score and positive lymph nodes, adjuvant LHRH agonist treatment is considered standard therapy. In patients with rising prostate specific antigen (PSA) after radical treatment, hormonal therapy is often applied in an intermittent way, but results remain inconclusive. Maximum androgen blockade (MAB), a combination of a LHRH agonist and an antiandrogen, has been applied in advanced prostate cancer. However, due to the increased incidence of side effects and very modest survival benefits, there are few arguments to offer this treatment strategy to patients with prostate cancer. In summary, LHRH agonist therapy is important in the treatment of both early and advanced prostate cancer. Additional studies are needed to further define the optimal use of LHRH agonists within various patient risk groups.