Dr. Cooperberg on Using Antagonists for Hormonal Therapy in Prostate Cancer

Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the efficacy and feasibility of using a GNRH antagonist rather than an agonist as hormonal therapy for men with prostate cancer.

It can be challenging to use the FDA-approved GNRH antagonist degarelix as a treatment of prostate cancer because it involves monthly injections, Cooperberg explains. This has been shown to be a barrier in practice, as patients are less likely to travel great distances on a monthly basis. However, some patients may start with an agonist before being transferred to an antagonist if they did not achieve a castrate level of testosterone.

The relevance of preventing micro-testosterone surges with an antagonist is unclear, Cooperberg suggests. In fact, for most patients starting on a hormonal therapy who have a detectable prostate-specific antigen or limited-burden metastatic disease, Cooperberg questions the significance of testosterone flare. Outside of this item, analyses have suggested that fewer cardiac or metabolic side effefts are seen with an antagonist compared with an agonist, but further studies need to be conducted to validate these findings, Cooperberg suggests.

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