© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
RehsiaAND Shayegan
32
the testes.
21
Androgen deprivation can be achieved
either by suppressing the secretion of testicular
androgens by surgical or medical castration, or by
inhibiting the action of circulating androgens on
receptors in prostate cells by using antiandrogens.
22
The most common method of hormone manipulation
is medical castration by administering luteinizing
hormone-releasing hormone (LHRH) agonists,
LHRH antagonists, or antiandrogens. See Table 1 for
a list of LHRH agonists and LHRH antagonists. See
Table 2 for a list of antiandrogen hormonal therapies
for prostate cancer. In recent years, there has been
concern about side effects from androgen deprivation
therapy. Common side effects include loss of lean
muscle mass, hot flashes, loss of bone mineral density,
decreased libido (and erectile dysfunction), cognitive
TABLE 1.
LHRH agonist and LHRH antagonists as hormonal therapy for prostate cancer
Name (Brand name)
Class
Administration
Notes
Buserelin
LHRH
SC: 500 mcg q8h X 7 days
Can cause initial
(
Suprefact
agonist
then 200 mcg daily;
hormonal surge
[
Canada only])
Depot 2-month:
6.3
mg implant every 8 weeks
Depot 3-month:
9.45
mg implant every 12 weeks
Intranasal: 400 mcg
(200
mcg into each nostril)
3
times/day
Degarelix
LHRH
Starting dose: 240 mg SC in 2 divided No hormonal surge;
(
Firmagon)
antagonist
doses. Maintenance dose: 80 mg SC
administer in
every month, first dose given one
abdominal wall
month after starting dose
Goserelin acetate
LHRH
3.6
mg SC monthly (28 days);
Can cause initial
(
Zoladex,
agonist
10.8
mg SC every 3 months (13 weeks) hormonal surge;
Zoladex LA)
SC resorbable
implant
Histrelin
LHRH
SC implant 50 mg every 12 months
Remove implant at
(
Vantas [US only])
agonist
reinsertion; local
anesthesia, place in
upper inner arm
Leuprolide
LHRH
7.5
mg IM monthly
Can cause initial
(
Lupron Depot)
agonist
22.5
mg IM every 3 months;
hormonal surge
30
mg IM every (16 weeks)
Leuprolide gel
LHRH
7.5
mg SC monthly;
Can cause initial
(
Eligard)
agonist
22.5
mg SC every 3 months;
hormonal surge;
30
mg SC every 4 months;
requires refrigerated
45
mg SC every 6 months
storage
Leuprolide implant
LHRH
SC implant every 12 months
Off US market for new
(
Viadur
agonist
(
contains 65 mg leuprolide)
patients since 2008
[
US, not Canada])
Triptorelin
LHRH
3.75
mg IM monthly
Can cause initial
(
Trelstar,
agonist
11.25
mg IM every 3 months
hormonal surge
Trelstar LA)
22.5
mg IM every 6 months (US only)
