GnRH Antagonists: Current Evidence and Role in Prostate Cancer

Area of Science:

• Oncology
• Endocrinology
• Pharmacology

Background:

• Androgen deprivation therapy (ADT) is a cornerstone in prostate cancer (PCa) management.
• Gonadotropin-releasing hormone (GnRH) agonists are the most common ADT, but GnRH antagonists offer an alternative.
• Antagonists provide rapid testosterone suppression without the initial flare effect seen with agonists.

Purpose of the Study:

• To provide a comprehensive literature review on the role of GnRH antagonists in PCa management.
• To highlight the potential benefits and limitations of GnRH antagonists.
• To address existing controversies regarding their efficacy and safety.

Main Methods:

• Narrative literature review.
• Analysis of existing clinical evidence and studies on GnRH antagonists (degarelix, relugolix).
• Evaluation of testosterone suppression, recovery, and cardiovascular risk profiles.

Main Results:

• GnRH antagonists achieve rapid testosterone suppression without flare.
• Relugolix (oral antagonist) shows rapid testosterone recovery post-treatment and potential for lower cardiovascular risk.
• Evidence on superiority over agonists in clinical outcomes and side effects is limited and sometimes contradictory.

Conclusions:

• GnRH antagonists represent a valuable option for personalized PCa treatment.
• Further long-term prospective studies are essential to confirm efficacy, safety, and cardiovascular risks.
• The definitive role of antagonists in various PCa stages and combination therapies needs further validation.