Degarelix for treating advanced prostate cancer

This is a new guideline from NICE advising that degarelix can be used in the treatment of hormone-dependent advanced prostate cancer.

When can it be used?

In people with spinal metastases.

How is it different from other treatments?

Degarelix is a selective gonadotrophin-releasing hormone antagonist. It reduces gonadotrophin release from the pituitary and hence testosterone production by the testes. Currently the subcutaneous implants we use are LHRH-agonists, that work in a similar way. However LHRH agonists cause an initial testosterone flare when treatment is started. There is some evidence that in patients with spinal mets, this testosterone flare can trigger sudden worsening and spinal cord compression.

Degarelix is non-inferior to LHRH-agonists, but much more expensive, hence the careful patient group selection.

It is given as a monthly subcut injection until disease progresses, so there is a good chance that we will end up giving this in general practice.

 

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