Leuprorelin Acetate

How it works

Continuous GnRH receptor stimulation initially raises and then, through receptor desensitisation, suppresses pituitary gonadotrophin release, lowering testosterone to castrate levels.

Prescribing in practice

• An initial testosterone surge ('tumour flare') can transiently worsen disease, including spinal cord compression or urinary obstruction, so co-prescribe an anti-androgen around initiation in patients at risk.
• Long-term androgen deprivation increases cardiovascular, metabolic and bone-density risks, warranting attention to overall risk factors.
• Use with caution and appropriate cardiac assessment where there is risk of QT prolongation, in line with the SPC.

Monitoring

Monitor PSA and testosterone response, together with bone health, glycaemic and cardiovascular risk factors during long-term therapy.

Counselling the patient

• Symptoms may briefly worsen when treatment starts; report new bone pain, weakness in the legs or difficulty passing urine urgently.
• Hot flushes, reduced libido, erectile dysfunction and fatigue are common.
• Attend for your scheduled depot injections to maintain testosterone suppression.

Evidence & guidelines

GnRH agonists are a standard means of achieving androgen deprivation in advanced prostate cancer and are recommended within NICE guidance.