Goserelin

How it works

Continuous GnRH receptor stimulation initially raises then suppresses pituitary gonadotrophin output, ultimately lowering testosterone or oestradiol to castrate levels.

Prescribing in practice

• In prostate cancer an initial testosterone surge can cause tumour flare, so co-administer an anti-androgen around initiation in those at risk of spinal cord compression or ureteric obstruction.
• Long-term use reduces bone mineral density; consider bone protection and cardiovascular risk in prolonged androgen deprivation.
• Administer the depot by subcutaneous implant at the scheduled interval as directed in current prescribing references.

Monitoring

Monitor testosterone or oestradiol suppression and treatment response, with attention to bone density during prolonged therapy.

Counselling the patient

• Hot flushes, reduced libido and sexual dysfunction are common; report bone pain or new urinary symptoms early.
• Attend appointments on time so depot injections are not delayed.
• Menstruation usually stops during treatment and returns after stopping in pre-menopausal women.

Evidence & guidelines

GnRH agonists are a cornerstone of androgen deprivation in prostate cancer and are recommended in NICE and international guidance.