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Degarelix drops testosterone after Lupron failure for 2 men


JimJimJimJim

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ADT, has one primary purpose - lower testosterone to castrate levels.

On occasion, for some men, the ADT does not achieve this castrate level of testosterone.

This may be noticed by doctors who test testosterone with each PSA test.

Doctors who do not test testosterone with each PSA test may find out by ordering a testosterone test when PSA fails to fall initially, or rises again later.

Whichever way the failure to lower testosterone is discovered, until now strategies have been limited. Physical castration has been a primary strategy.

The paper below reports two men who had testosterone levels way above castrate levels. By changing the ADT treatment from Lupron (leuprolide) to the new Firmagon (degarelix), they were spared the knife.

Anticancer Drugs. 2011 Mar;22(3):299-302.

Response to degarelix after resistance to luteinizing hormone-releasing hormone agonist therapy for metastatic prostate cancer.

Raddin RS, Walko CM, Whang YE.

Source

Division of Hematology-Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Abstract

Androgen deprivation with a luteinizing hormone-releasing hormone (LH-RH) agonist is the standard treatment for patients with metastatic prostate cancer who prefer nonsurgical options. Therapy with these agents is usually successful in achieving and maintaining castrate levels (< 50 ng/dl) of serum testosterone, but failures have been reported in up to 10% of patients. Traditionally, these patients are offered surgical castration with bilateral orchiectomy. However, the novel LH-RH antagonists may offer a nonsurgical alternative. We describe two patients with advanced prostate cancer who failed to achieve castrate levels of testosterone while on an LH-RH agonist, but subsequently responded to the LH-RH antagonist, degarelix. The first patient is a 63-year-old man who was treated with leuprolide for metastatic prostate cancer. He initially responded with prostate-specific antigen (PSA) that fell to 0.6 ng/ml. However, after 15 months of therapy, his PSA rose to 18.3 ng/ml and his testosterone was noted to be 208 ng/dl. He was switched to degarelix, and 4 weeks later his testosterone was adequately suppressed at 16 ng/dl. The second patient is a 41-year-old man with metastatic prostate cancer who was started on leuprolide, but after 3 months of therapy, was found to have a rising PSA and a testosterone of 96 ng/dl. Four weeks after switching to degarelix, his testosterone was 18 ng/dl and his PSA decreased concordantly. With continued monthly injections of degarelix, his testosterone has consistently remained to be at less than 20 ng/dl over 7 months of follow-up.

PMID: 21360851

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).

Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

The patients in this study initially had implants of Lupron (leuprolide), an LHRH agonist for their ADT.

Other LHRH agonists are Zoladex (Goserelin), Eligard (leuprolide), Suprefact (buserelin), Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin (deslorelin), Ovuplant(deslorelin), Triptorelin.

As the LHRH agonist wasn't working, they were given one of the newer GnRH antagonists.

GnRH antagoinsts include Abarelix and Firmagon (degarelix).

Testosterone levels are quoted with different levels in different countries.

If you are trying to compare your own testosterone levels with levels quoted, a conversion calculation needs to be done.

Your doctor, of course, will advise you on this.

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