Hormone therapy, also known as androgen deprivation therapy (ADT), is a cornerstone in the management of prostate cancer. It functions by reducing levels of male hormones, particularly testosterone, which can fuel the growth of prostate cancer cells. ADT is effective in both localized prostate cancer when combined with radiation therapy and in metastatic settings.
Role of ADT in Prostate Cancer Treatment
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Localized Prostate Cancer with Radiation Therapy: In cases where prostate cancer is confined to the prostate gland, combining ADT with radiation therapy has been shown to enhance treatment efficacy. ADT helps by sensitizing cancer cells to radiation, thereby improving overall outcomes.
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Metastatic Prostate Cancer: For cancer that has spread beyond the prostate, ADT remains a primary treatment modality. By lowering testosterone levels, ADT can slow disease progression and alleviate symptoms, thereby improving quality of life.
Relugolix has better suppression, faster recovery of testosterone, but is more expensive
When considering ADT options, patients often choose between oral medications like relugolix and injectable luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide (Eligard). The main advantage of the relugolix is that it has a much better testosterone recovery rate and timeline after treatment.
Testosterone Recovery Post-ADT
The duration of ADT significantly influences the likelihood and timing of testosterone recovery after treatment cessation. Longer durations of ADT are associated with delayed and reduced rates of testosterone normalization.
Statistics on Testosterone Recovery Based on Injectable ADT Duration
Studies have demonstrated varying recovery rates depending on the length of injectable ADT:
| ADT Duration | Percentage of Patients Recovering Normal Testosterone Levels | Median Time to Recovery |
|---|---|---|
| 6 months | 75.9% | 1.64 years |
| 18 months | 54.8% | 3.06 years |
| 36 months | 43.2% | 5.0 years |
Table: Relationship between ADT duration and testosterone recovery rates.
These findings underscore that extended ADT durations are linked to both lower recovery rates and prolonged recovery periods. pubmed.ncbi.nlm.nih.gov+2urotoday.com+2en.wikipedia.org+2
Advantages of Relugolix
Relugolix can mitigate the issue of testosterone recovery and decrease the time at which your testosterone levels are castrate level unnecessarily. Its oral administration allows for rapid discontinuation if adverse effects occur, thereby granting patients greater control over their treatment. This feature can be particularly beneficial for those who experience difficult side effects and wish to halt therapy promptly.
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Side Effects:
- Common side effects of ADT include hot flashes, fatigue, decreased libido, and potential cardiovascular risks. Notably, relugolix has been associated with a 54% lower risk of major adverse cardiovascular events compared to leuprolide. nejm.org
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Cost Considerations:
- The cost of relugolix can be higher than that of leuprolide. Most patients with medicare or a medicare advantage plan will meet their annual out-of-pocket maximum ($2000 for 2025) on relugolix. This is the primary disadvantage of relugolix.
Common Side Effects of ADT and Their Incidence
- Hot Flashes: Up to 80% of patients may experience hot flashes during ADT.
- Sexual Dysfunction: Approximately 85% of men report reduced libido and erectile dysfunction.
- Fatigue: Around 70% of patients may feel increased fatigue.
- Bone Density Loss: Long-term ADT can lead to osteoporosis; about 20% of men may experience significant bone loss.
- Metabolic Changes: There’s an increased risk of weight gain, insulin resistance, and lipid profile changes.
It’s essential for patients to discuss these potential side effects with their healthcare provider to manage and mitigate them effectively.
Testosterone Recovery – Based on data from the HERO trial, at 90 days post treatment, 55% of men on relugolix regained normal testosterone levels vs. 3% with injectable ADT.
Conclusion
Both relugolix and injectable LHRH agonists are effective in reducing testosterone levels for prostate cancer treatment. However, the duration of ADT plays a pivotal role in post-treatment hormonal recovery, with longer treatments leading to reduced and delayed testosterone normalization. Patients should discuss these aspects with their healthcare providers to make informed decisions tailored to their individual health profiles and treatment goals.
Studies indicate that testosterone recovery is faster and more reliable with relugolix compared to leuprolide.
