Editing Hormonal Therapy (section)

===== LHRH agonists =====
* '''<span style="color:#ff0000">As effective as orchiectomy</span>'''
** Initially, the clinical utility of LHRH agonists were hampered by their short half-life, requiring daily injections. The generation of long-acting depot preparations, lasting several months, has established LHRH agonists as the dominant treatment in hormone therapy for prostate cancer.
* '''<span style="color:#ff0000">Initially co-administered with an androgen-receptor antagonist to block the LH and testosterone surge</span>'''
** Initial exposure to LHRH agonists results in a surge of LH (up to 10x) and testosterone levels. This '''surge''' '''can result in a severe, life-threatening exacerbation of symptoms'''
** Co-administration of an anti-androgen (bicalutamide 50mg daily) functionally blocks the increased levels of testosterone.
*** '''The testosterone flare may last for 10-20 days and therefore co-administration of anti-androgen is required for only 21-28 days'''
**** Although some have argued that the administration of the anti-androgen should precede the administration of the LHRH agonist by at least a week, others have found no differences in PSA levels with the simultaneous administration of both agents.
** '''Following the LH surge, the loss of phasic pituitary stimulation results in plummeting LH levels'''
** '''In the absence of LH, Leydig cell production of testosterone drops to castrate levels'''
* <span style="color:#ff0000">'''Drugs and Dosages'''</span>
** <span style="color:#0000ff">'''-relin/-rolide'''</span><span style="color:#ff0000">''', Goserelin (Zoladex), Triptorelin (Trelstar) and Leuprolide (Lupron)'''</span>
**Goserelin (Zoladex) 10.8mg SC q3 months
** Leuprolide (Lupron) 22.5mg SC q3months