Sudden Death due to Disease Flare with Luteinizing Hormone-Releasing Hormone Agonist Therapy for Carcinoma of the Prostate

Thompson, Ian M.; Zeidman, Eric J.; Rodriguez, Francisco R.

doi:10.1016/s0022-5347(17)39774-4

Cited by 107 publications

(59 citation statements)

References 11 publications

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“…Initially, however, GnRH agonists stimulate LH production, which in turn causes a surge of testosterone and DHT for 5 to 12 days before inhibition of LH [2]. This androgen surge of male hormones can cause a flare reaction ("clinical flare") [2,14,15]. Clinical flare is often painful and always dangerous.…”

Section: Agonistsmentioning

confidence: 99%

Development of GnRH Antagonists for Prostate Cancer: New Approaches to Treatment

2000

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Prostate cancer has become the most common cancer among American men and is second only to lung cancer as a cause of male cancer‐related death. Several treatment options exist for different stages of prostate cancer including observation, prostatectomy, radiation therapy, chemotherapy, and hormone therapy. Hormone therapy has evolved from the use of estrogens to gonadotropin‐releasing hormone (GnRH) agonists and recently, investigational GnRH antagonists. GnRH receptor agonists such as leuprolide, bruserelin and goserelin have been used for the treatment of prostate cancer. These agonists eventually cause the inhibition of lutenizing hormone production, which in turn causes a suppression of testosterone and dihydrotestosterone, on which continued growth of prostate cancer cells depend. Several comparative studies of leuprorelin administered as daily injections or monthly depot injections have been reported. Disease progression was prevented in more than 72% of men administered daily leuprorelin, and in 82% to 89% of those receiving monthly depots. Another synthetic GnRH analog, goserelin, has been studied in a similar population of men with daily injections producing partial responses in 60% to 80% of men with previously untreated prostate cancer. Abarelix, a peptide antagonist of GnRH receptor, is also being studied for the treatment of prostate cancer. The discovery and development of GnRH antagonists may provide an important advance for patients with prostate cancer. Clearly the studies described herein, as well as many others, outline an exciting era of research to define the optimal use of hormonal therapy in prostate cancer.

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Section: Agonistsmentioning

confidence: 99%

Development of GnRH Antagonists for Prostate Cancer: New Approaches to Treatment

2000

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“…However, flare during simple LHRH agonist treatment has been demonstrated in the past on many occasions. It might increase progression rates and even cause death in some patients [13]. …”

Section: Discussionmentioning

confidence: 99%

Maximum Androgen Blockade Using LHRH Agonist Buserelin in Combination with Short-Term (Two Weeks) or Long-Term (Continuous) Cyproterone Acetate Is Not Superior to Standard Androgen Deprivation in the Treatment of Advanced Prostate Cancer

Voogt

Studer²,

Schröder³

et al. 1998

European Urology

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“…In cases with metastatic disease, especially in symptomatic patients, the initial rise of plasma testosterone can lead to an increase of clinical symptoms and even death (the flare phenomenon) which is usually prevented by an anti-androgen at least during the initial treatment period (Thompson et al 1990). Continuous treatment by combining an LHRH agonist and an anti-androgen (total androgen blockade or maximal androgen blockade) is not discussed in this review, which will be limited to the side effects of castration and LHRH monotherapy, the treatment principles most frequently used in early versus delayed regimens.…”

Section: Adverse Effects Of Etmentioning

confidence: 99%

Early versus delayed endocrine therapy for prostate cancer

Schröder

2007

Endocr Relat Cancer

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Endocrine treatment (ET) has in the past been shown to be beneficial in delaying clinical progression in all stages of prostate cancer, leading to an improvement of progression free survival in virtually all trials ever conducted. The first observations on this issue date back to the studies of the Veterans Administration Cooperative Urological Research Group in the 1960s. The period of time during which ET and the resulting side effects can be avoided is strongly dependent on the clinical stage of the disease. This treatment period is long in men who have minimal disease, such as a rising prostate-specific antigen after potentially curative management; however, it is considerably shorter in men who initially present with metastatic disease. In these situations, the potential benefit in quality of life, and avoidance of adverse events must be matched against the benefit in terms of gaining progression free time for the individual patient. This difficult task is supported by information supplied in this review. Locally advanced and regional (lymph node positive; stage T3N0-1M0Gx) disease is the domain of adjuvant ET. In this field, important progress has recently been made due to trials, which combine aggressive treatment of the primary tumor with adjuvant ET initiated at the same time. Therefore, in locally advanced and regional disease, radiotherapy or surgery combined with adjuvant ET must be considered state-of-the-art.

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Sudden Death due to Disease Flare with Luteinizing Hormone-Releasing Hormone Agonist Therapy for Carcinoma of the Prostate

Cited by 107 publications

References 11 publications

Development of GnRH Antagonists for Prostate Cancer: New Approaches to Treatment

Development of GnRH Antagonists for Prostate Cancer: New Approaches to Treatment

Maximum Androgen Blockade Using LHRH Agonist Buserelin in Combination with Short-Term (Two Weeks) or Long-Term (Continuous) Cyproterone Acetate Is Not Superior to Standard Androgen Deprivation in the Treatment of Advanced Prostate Cancer

Early versus delayed endocrine therapy for prostate cancer

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