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.