Search Videos by Topic or Participant
Browse by Series:

LHRH Agonists Versus Antagonists in Prostate Cancer

Panelists: David Albala, MD, Crouse Hospital; E. David Crawford, MD, University of Colorado ; Raoul S. Concepcion, MD, Urology Associates, PC; Vahan Kassabi
Published: Thursday, Feb 20, 2014
For High-Definition, Click
For patients with advanced prostate cancer, LHRH agonists have provided successful androgen deprivation therapy (ADT) for several years. However, following the administration of these agents, FSH and LH levels may briefly increase, causing an initial surge in testosterone levels that may worsen some conditions. LHRH antagonists, on the other hand, tend to reduce testosterone levels more quickly and do not cause flares, advocates E. David Crawford, MD.

In addition to a reduction in testosterone-induced flare, which may still occur despite complete androgen blockade, treatment with antagonists results in fewer joint-related, musculoskeletal, and urinary tract complications compared with agonists, notes Crawford. Moreover, antagonists appear to maintain castrate levels of testosterone for longer durations, suggesting an improvement in survival.

Studies have indicated that ADT with LHRH agonists could be associated with cardiovascular events and death, resulting in past FDA safety warnings. In general, Crawford notes, these warnings were made concerning agonists and not antagonists. For men with a prior history of cardiovascular disease, there is a 9% risk of cardiovascular death with an agonist compared with a 3% risk with antagonists, Crawford notes. The relationship between agonists and cardiovascular events may be related to increases in T cells, cytokines, and inflammation following treatment, which do not occur as frequently with antagonists, Crawford believes.
Slider Left
Slider Right
For High-Definition, Click
For patients with advanced prostate cancer, LHRH agonists have provided successful androgen deprivation therapy (ADT) for several years. However, following the administration of these agents, FSH and LH levels may briefly increase, causing an initial surge in testosterone levels that may worsen some conditions. LHRH antagonists, on the other hand, tend to reduce testosterone levels more quickly and do not cause flares, advocates E. David Crawford, MD.

In addition to a reduction in testosterone-induced flare, which may still occur despite complete androgen blockade, treatment with antagonists results in fewer joint-related, musculoskeletal, and urinary tract complications compared with agonists, notes Crawford. Moreover, antagonists appear to maintain castrate levels of testosterone for longer durations, suggesting an improvement in survival.

Studies have indicated that ADT with LHRH agonists could be associated with cardiovascular events and death, resulting in past FDA safety warnings. In general, Crawford notes, these warnings were made concerning agonists and not antagonists. For men with a prior history of cardiovascular disease, there is a 9% risk of cardiovascular death with an agonist compared with a 3% risk with antagonists, Crawford notes. The relationship between agonists and cardiovascular events may be related to increases in T cells, cytokines, and inflammation following treatment, which do not occur as frequently with antagonists, Crawford believes.
View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Personalized Sequencing in Castration-Resistant Prostate Cancer: Bridging the Latest Evidence to the Bedside in Clinical ManagementAug 25, 20181.5
Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer CareNov 30, 20181.0
Publication Bottom Border
Border Publication
x