LH-RH analogs

These are synthetic products with chemical structures almost identical to natural LH-RH. Initially, they behave like LH-RH and stimulate the release of luteinizing hormone from the pituitary gland, causing an increase in testosterone production. But after a short period, they block the release of luteinizing hormone and reduce testosterone secretion from the testicles. The result is testosterone levels similar to those that occur after surgical castration or with estrogen. LH-RH analogs are equivalent to surgical castration and estrogen in their ability to delay progression of cancer and prolong survival.

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Commonly used LH-RH analogs are goserelin (Zoladex), leuprolide (Eligard, Lupron), and triptorelin (Trelstar). LH-RH analogs are traditionally given as injections every month or every three months. Another option is an implanted drug delivery system (Viadur) that reduces leuprolide continuously for one year.

The initial increase in testosterone with LH-RH analogs may be severe enough to exacerbate bone pain in men with prostate cancer that has spread to the bones and can be prevented with an antiandrogen until testosterone levels fall to the castrate range about two to three weeks later. Other side effects of the LH-RH analogs include erectile dysfunction, loss of libido, hot flashes, weight gain, fatigue, and decreased bone and muscle mass. In addition, some men experience irritation at the injection sites. LH-RH analogs are less likely than estrogen to cause breast enlargement, nausea, vomiting, and cardiovascular problems.