LUTEINIZING-HORMONE-RELEASING HORMONE ANTAGONIST CETRORELIX AS PRIMARY SINGLE THERAPY IN PATIENTS WITH ADVANCED PROSTATIC-CANCER AND PARAPLEGIA DUE TO METASTATIC INVASION OF SPINAL-CORD
D. Gonzalezbarcena et al., LUTEINIZING-HORMONE-RELEASING HORMONE ANTAGONIST CETRORELIX AS PRIMARY SINGLE THERAPY IN PATIENTS WITH ADVANCED PROSTATIC-CANCER AND PARAPLEGIA DUE TO METASTATIC INVASION OF SPINAL-CORD, Urology, 45(2), 1995, pp. 275-281
Objectives. To assess the clinical response to luteinizing hormone-rel
easing hormone (LH-RH) antagonist cetrorelix (SE-75) in patients with
advanced carcinoma of the prostate and paraplegia due to metastatic in
vasion of spinal cord. Methods. Cetrorelix was given at two different
dose regimens to 5 patients with prostatic cancer Stage D2 and paraple
gia. Urologic and neurologic examinations, laboratory studies, radiogr
aphy (myelography), and prostate ultrasonography were carried out. Pro
state-specific antigen (PSA) and free testosterone were also measured.
Results. In all patients, the neurologic symptoms regressed. The reco
very of the thermic and vibratory sensation and motility of the toes w
as observed. The neurologic improvement continued during the treatment
and at 3 months all the patients were able to walk with the aid of a
cane. In 1 patient, the myelography showed that the spinal cord compre
ssion had disappeared and prostate volume assessed by ultrasonography
showed a significant decrease. The bladder function greatly improved i
n all 5 patients during the treatment with cetrorelix. Baseline levels
of luteinizing hormone fell from 9.28 to 1.0 IU/L and those of follic
le-stimulating hormone (FSH) fell from 18.28 to 12 IU/L (P < 0.05) aft
er the first day of therapy with cetrorelix. Mean levels of free testo
sterone were reduced from 52.4 to 14.7 pmol/L (P < 0.005) at 12 hours
and to 13.1 pmol/L (P < 0.005) 3 days after the first injection of cet
rorelix. A persistent inhibition of gonadotropins and testosterone was
maintained during the subsequent 3 months of therapy, The high levels
of PSA gradually decreased. Conclusions. Our results show that LH-RH
antagonist cetrorelix causes an immediate lowering of the serum testos
terone levels in patients with prostate cancer and metastases in the s
pinal cord, in whom the LH-RH agonists cannot be used as single drugs
because of the possibility of flare-up and appears to be appropriate f
or long-term therapy.