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

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.