Gonadotropin-releasing hormone agonists in prostate cancer: A comparative review of efficacy and safety.
Raja. T T; Sud. Rahul R; Addla. Sanjai S; Sarkar. Kalyan K KK; Sridhar. P S PS; Talreja. Vikas V; Jain. Minish M; Patil. Ketaki K
Key Findings
- All GnRH‑agonists (goserelin, triptorelin, buserelin, histrelin, leuprorelin) suppress testosterone to ≤50 ng/dL within a month and ≤20 ng/dL within three months.
- Goserelin may maintain low testosterone better than leuprolide and has fewer testosterone‑escape events than buserelin.
- Survival rates as adjuvant therapy are similar across agents (e.g., triptorelin 8‑year survival ~84.6% after prostatectomy).
- Adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the drugs.
- Goserelin is reported as the most convenient to administer.
Practical Outcomes
- If you or someone you know needs medical testosterone suppression for prostate cancer, any of these drugs will work, with triptorelin offering comparable efficacy and safety to the others. The choice can be based on convenience, cost, or physician preference, as there’s no major advantage of triptorelin over the others for general health optimization.
Summary
This review shows that all the GnRH‑agonist drugs, including triptorelin, drop testosterone to very low levels (≤50 ng/dL in a month, ≤20 ng/dL in three months) and have similar side‑effects, but goserelin may keep testosterone a bit lower and is the easiest to give. Survival numbers differ a little between drugs, but overall they work about the same for prostate cancer treatment.
Abstract
Androgen deprivation therapy (ADT) using gonadotropin-releasing hormone agonist (s) (GnRH-A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH-A. All GnRH-A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (≤50 ng/dL in a month and ≤20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ≤50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate-specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10-year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10-year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10-year survival rate of 87%, and triptorelin had an 8-year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH-A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH-A. Goserelin appears to be the most convenient of all the GnRH-A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH-A for ADT in prostate cancer.
Study Information
pubmed
2022
10.4103/ijc.ijc_65_21