Goserelin

How it works

Continuous GnRH-receptor stimulation initially raises and then, through pituitary receptor downregulation, suppresses LH and FSH release, lowering testosterone to castrate levels.

Prescribing in practice

• An initial testosterone surge ("flare") can transiently worsen prostate cancer symptoms such as bone pain or urinary obstruction, so cover with an anti-androgen around the first injection, especially in metastatic disease with spinal risk.
• Administer the depot by deep subcutaneous injection into the anterior abdominal wall at the scheduled interval to maintain suppression.
• Long-term androgen deprivation increases cardiovascular, metabolic and bone-density risks, so assess and manage these proactively.

Monitoring

Monitor testosterone and PSA response, together with bone health, glycaemic and cardiovascular risk during prolonged therapy.

Counselling the patient

• Expect symptoms to possibly worsen briefly before improving when treatment starts.
• Hot flushes, reduced libido and erectile dysfunction are common; report new or worsening bone pain or urinary difficulty.

Evidence & guidelines

GnRH agonists including goserelin are an established standard of care for androgen-deprivation therapy in prostate cancer, supported by long-term trial and guideline data.