‘Nurse: My back hurts!’: case study review of Degarelix in metastatic prostate cancer

Abstract

In the management of metastatic prostate cancer, treatment with androgen deprivation therapy, initially with surgery via bilateral orchidectomy and more recently with medical therapy using gonadotropin‐releasing hormone (GnRH) agonists, has remained the key treatment approaches for this disease stage. Notably, patients express a preference towards a medical therapy approach. We present the case study of a patient with symptomatic metastatic prostate cancer treated with the new GnRH antagonist degarelix.

Degarelix relieves hydronephrosis in a patient with prostate cancer: case study

“…LHRH agonists such as Leuprorelin, Goserelin and Triptorelin have become the treatment of choice for the majority of patients with advanced prostate cancer but these drugs do have limitations: The initial physiological response to leutenising hormone releasing hormone (LHRH) agonists results in an initial stimulation and secretion of leutenizing hormone (LH) and follicle stimulating hormone (FSH) causing a tumour flare phenomenon which may stimulate prostate cancer cells to grow which may cause an exacerbation of clinical symptoms such as spinal cord compression, bone pain and ureteric obstruction (Turner et al , ). Non‐steroidal anti‐androgen medication is administered for a period of time before and after the initial LHRH agonist to prevent the tumour flare phenomenon but this adds to treatment costs, relies on patient concordance, increases the number of medications a patient needs to take (albeit for a short time) and has the added potential serious side effect of hepatotoxicity and milder side effects such as gastrointestinal disturbance (Chrousos, ).…”

The role of gonadotrophin-releasing hormone antagonists in the treatment of patients with advanced hormone-dependent prostate cancer in the UK

“…The clinical benefits of rapid testosterone reduction to castrate levels include reduction in intensity of lumbar back pain [32] and resolution of hydronephrosis and other LUTS [33]. Although the extension study from the degarelix phase 3 study has suggested some improvement in PSA-PFS [17], there are limited data available to make any firm conclusions regarding the benefits of switching between ADT modalities.…”