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Challenges with luteinizing hormone-releasing hormone agonists: flare and surge

Michael K Brawer

    Reviews in Urology
    |September 21, 2006
    PubMed

    Insights

    Androgen deprivation therapy is a key treatment for prostate cancer. Luteinizing hormone-releasing hormone (LHRH) agonists are common, but their initial testosterone surge, or "flare," may increase risks in advanced disease.

    Area of Science:

    • Oncology
    • Endocrinology

    Background:

    • Androgen deprivation therapy (ADT) is a primary treatment for prostate cancer.
    • Pharmacologic approaches, like luteinizing hormone-releasing hormone (LHRH) agonists, are increasingly used over orchiectomy or estrogens due to side effects.
    • LHRH agonists can cause a testosterone surge, known as the "flare" phenomenon.

    Purpose of the Study:

    • To review the role of circulating androgens in prostate cancer.
    • To discuss the use and side effects of LHRH agonists in ADT.
    • To highlight the clinical significance of the "flare" phenomenon.

    Main Methods:

    • Literature review on androgen function in prostate cancer.
    • Analysis of clinical data regarding LHRH agonist use and side effects.
    • Evaluation of the "flare" phenomenon and its impact on patient morbidity.

    Main Results:

    • Circulating androgens play a role in prostate cancer progression, though mechanisms are not fully elucidated.
    • LHRH agonists are effective in ADT but associated with the "flare" phenomenon.
    • The "flare" can lead to severe complications, including pain, spinal cord compression, and potentially increased morbidity in advanced disease.

    Conclusions:

    • While ADT is crucial for prostate cancer, LHRH agonists require careful consideration due to the "flare" effect.
    • Avoiding the "flare" phenomenon may be beneficial for patients with advanced prostate cancer.
    • Further research is needed to fully understand the implications of "flare" and optimize ADT strategies.

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