Opinion
Video
The Current Landscape of ADT in Prostate Cancer
Panelists discuss how the treatment paradigm for androgen deprivation therapy is evolving from traditional injectable GnRH agonists to include oral GnRH antagonists like relugolix, which offer more rapid onset, faster recovery, and avoidance of testosterone flare.
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The landscape of androgen deprivation therapy (ADT) in prostate cancer has undergone significant transformation, moving beyond traditional injectable GnRH agonists like leuprolide and goserelin to include innovative oral alternatives. Kelly L. Stratton, MD, FACS, a urologic oncologist at the University of Oklahoma's Stevenson Cancer Center, explains how relugolix represents a paradigm shift as an oral GnRH antagonist that works through a different mechanism than traditional therapies.
Unlike injectable GnRH agonists that initially stimulate testosterone production before suppressing it, relugolix directly blocks LH and FSH production, eliminating the risk of testosterone flare. This mechanism provides immediate testosterone suppression without the anxiety-inducing initial testosterone spike that concerns both patients and physicians, particularly in cases involving spinal metastases where neurologic complications could arise.
The oral formulation offers multiple clinical advantages including rapid onset of action, faster recovery of testosterone levels upon discontinuation, potentially better cardiovascular safety profile, and enhanced patient convenience. These benefits align with the growing emphasis on patient-centered care and shared decision-making in prostate cancer treatment, providing urologists with more flexible and patient-friendly options for implementing ADT across the disease spectrum.
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