What is new in hormone therapy for prostate cancer in 2007?

Tombal, Bertrand [UCL]

Objectives: This paper assesses the importance of achieving optimal testosterone control in patients with prostate cancer (PCa) treated by androgen-deprivation therapy (ADT). Methods: This is a report on the interactive discussion between urologists and an expert panel during the Oncoforum summary meeting held in Brussels, Belgium. Results: The therapeutic effect of ADT relies on a rapid, profound, and sustained suppression of testosterone. Despite decades of research, the level of testosterone at which PCa cell death is triggered is not yet known. The historical reference being orchidectomy, we expect that similar testosterone levels will be reached when using luteinising hormone-release hormone (LHRH) agonists (+/-15 ng/dl). Several investigations have demonstrated that most LHRH agonists fail to reach testosterone levels <= 20 ng/dl in 13.0-46.4% of patients. In addition, mini-flares occur when injections are repeated in +/-10% of the patients, whereas breakthrough testosterone escapes occur in 4.0-12.5% of patients. Eligard (R) 1-, 3-, and 6-mo are modern formulations of leuprorelin with improved pharmacological performances; >88% of patients achieve testosterone levels <= 20 ng/dl, and mini-flares and breakthrough escapes are rarely observed. Conclusions: Eligard may provide testosterone control comparable to surgical castration. In addition, a 6-mo formulation may require less frequent visits to the doctor, offering therefore less inconvenience to the patients. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.