Failure to achieve castrate levels of testosterone during luteinizing hormone releasing hormone agonist therapy: The case for monitoring serum testosterone and a treatment decision algorithm
Mg. Oefelein et R. Cornum, Failure to achieve castrate levels of testosterone during luteinizing hormone releasing hormone agonist therapy: The case for monitoring serum testosterone and a treatment decision algorithm, J UROL, 164(3), 2000, pp. 726-729
Purpose: We report the failure to achieve a castrate level of testosterone
associated with 3-month depot luteinizing hormone releasing hormone (LH-RH)
agonist therapy, which to our knowledge is a previously unrecognized outco
me.
Materials and Methods: We prospectively enrolled in our study 38 men with p
rostate cancer on 3-month depot LH-RH agonist therapy. We monitored total s
erum testosterone and prostate specific antigen every 28 days beginning 90
days after the last depot LK-RH agonist injection. Data were analyzed with
castrate testosterone defined as less than 50 and 20 ng./dl. or less.
Results: Using the 50 and 20 ng./dl. definitions of castrate testosterone 2
(5%) and 5 (13%) of the 38 men, respectively, failed to achieve castrate t
estosterone. A patient with a nadir testosterone of 70 ng./dl. subsequently
underwent orchiectomy and testosterone decreased to 10 ng./dl. thereafter.
Conclusions: A small but potentially important subgroup of men on depot LH-
RH agonist therapy fail to achieve a castrate level of testosterone. Our fi
ndings support monitoring testicular response when LH-RH agonist therapy is
initiated.