Leuprorelin acetate

How it works

Sustained GnRH-receptor agonism downregulates pituitary receptors after an initial stimulation, suppressing LH and FSH and reducing testosterone to castrate levels.

Prescribing in practice

• An initial testosterone flare can transiently worsen disease, including risk of spinal cord compression or urinary obstruction in metastatic prostate cancer, so co-prescribe an anti-androgen around initiation.
• Administer the depot at the scheduled interval by the licensed route (subcutaneous or intramuscular depending on preparation) and rotate sites.
• Long-term androgen deprivation carries cardiometabolic and osteoporosis risks that should be assessed and managed.

Monitoring

Monitor testosterone and PSA for treatment response, alongside bone, metabolic and cardiovascular risk during prolonged use.

Counselling the patient

• Symptoms may briefly worsen when treatment begins before improving.
• Hot flushes, reduced libido and erectile dysfunction are common; report new bone pain or difficulty passing urine.

Evidence & guidelines

Leuprorelin and other GnRH agonists are an established standard for androgen-deprivation therapy in prostate cancer, supported by extensive trial evidence.