Determining Dosing Intervals For Luteinizing Hormone Releasing Hormone Agonists Based On Serum Testosterone Levels: A Prospective Study

Main Category: Urology / Nephrology
Also Included In: Endocrinology;  Clinical Trials / Drug Trials
Article Date: 11 Jun 2007 - 0:00 PDT

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UroToday.com- Dr. Pathak and associates from Kaiser Permanente, Los Angeles published an article in the June 2007 issue of the Journal of Urology, basing the frequency of LHRH agonist serum on testosterone levels. They found that the median dosing interval to be 6 months.

Patients usually receive a depot injection of an LHRH agonist based upon pharmaceutical recommendations. The most common schedule is every 3 months. However, the goal is to maintain serum testosterone at a castrate level of <50ng/dl. This study based the dosing interval on when the serum testosterone level exceeded the castrate level.

Between 2003 and 2005, 42 men were prospectively enrolled in the study. PSA and testosterone levels were obtained prior to initiating LHRH therapy, after 24 weeks and monthly thereafter. If serum testosterone was <50ng/dl then the next dose was held until the level exceeded the castrate level. A serum testosterone level >50ng/dl despite LHRH therapy resulted in consideration of second line hormonal therapy.

Mean patient age was 78.5 years, median pretreatment PSA was 15ng/ml, and pretreatment testosterone was 300ng/dl. Mean follow-up was 18 months and median post-treatment PSA was 0.745ng/ml. The median dosing interval was 6.0 months. No patients required more frequent dosing than every 5 months. The authors suggest that this information may have significant impact on the expense of this treatment. However, intermittent androgen deprivation may soon be validated as the new standard of care and would be even more cost effective.

Pathak AS, Pacificar JS, Shapiro CE, Williams SG

J Urol.177 (6):2132-2135, June 2007
doi:10.1016/j.juro.2007.01.157
Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D.

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