Drug Forms And Administration
Eligard and Lupron Depot are both given as an injection. However, administration of the injection for each drug is different.
Eligard is given as a subcutaneous injection . Lupron Depot is given as an intramuscular injection . You receive either injection from a healthcare professional in a doctors office or hospital.
Depending on your dose and your doctors recommendations, you may receive an Eligard or a Lupron Depot dose once per month, or once every 3, 4, or 6 months.
Note: Another form of Lupron Depot, called Lupron, used to be available. Lupron was also approved as a palliative treatment for advanced prostate cancer. Like Eligard, it was given as a subcutaneous injection. At this time, Lupron has been discontinued.
Do You Have To Take Hormones For Life
Theres no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.
Are there risks to stopping HRT? The most likely risk is that your menopausal symptoms return Some research also suggests a rise in blood pressure and a slight increase in risk of heart attack or stroke in the year after stopping HRT.
Eligard Use With Other Drugs
Its possible youll take Eligard with other medications to manage your advanced prostate cancer. Treatment for your specific prostate cancer may depend on other conditions that you have and how advanced your cancer is.
Current treatment guidelines for advanced prostate cancer may recommend using a gonadotropin-releasing hormone agonist, such as Eligard, with other medications. GnRH agonists are often used with androgen deprivation therapy , especially at the beginning of treatment.
ADT drugs block androgen hormones, such as testosterone, from working in your body. Testosterone fuels the production of prostate cancer cells.
When you first start taking Eligard, your testosterone levels may actually increase for the first week or two of treatment. This means that your symptoms of prostate cancer may get worse before they improve.
Therefore, your doctor may recommend that you take an ADT, especially during your first few weeks of treatment. This can help prevent your symptoms from getting worse.
Examples of ADT medications include:
Your doctor may also recommend taking an ADT medication with Eligard if you have prostate cancer that has come back after treatment or that hasnt improved with other medications, like ADT drugs alone or radiation treatment. Talk with your doctor about the best treatment options for you.
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Treatment To Lower Testicular Androgen Levels
Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.
Orchiectomy
Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.
This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.
Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.
LHRH agonists
Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.
With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.
- Leuprolide mesylate
LHRH antagonists
Possible side effects
Many side effects of hormone therapy can be prevented or treated. For example:
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How Eligard Is Administered
Eligard administration requires a specific injection technique, so youll receive the medication from a healthcare professional at a doctors office or hospital.
As packaged, Eligard isnt ready to inject. It comes as a powder and a liquid that a healthcare professional needs to mix together. Once theyve prepared Eligard and given you an injection, the drug forms a gel in your body.
Over the next month or months , the drug is slowly released into your body. This is why you only need to get an injection once per month or every few months.
Effect On Qt/qtc Interval
Androgen deprivation therapy may prolong the QT/QTc interval. Providers should consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities, and in patients taking drugs known to prolong the QT interval. Electrolyte abnormalities should be corrected. Consider periodic monitoring of electrocardiograms and electrolytes.
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Study Design And Conduct
ELIGANT was a Phase 4, multicenter, prospective, single-arm, open-label interventional study conducted at 20 centers throughout Asia, including sites in Hong Kong, Indonesia, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam.
Figure 1
This study was conducted in accordance with the Declaration of Helsinki , Good Clinical Practice, International Council for Harmonisation guidelines, and applicable local laws and regulations. The study was approved by an independent ethics committee or institutional review board at each location and all patients were required to provide written informed consent prior to participating in the study.
Before Taking This Medicine
You should not use Eligard if you are allergic to leuprolide or similar medicines such as buserelin, goserelin, histrelin, nafarelin, or if you have abnormal vaginal bleeding that has not been checked by a doctor.
Leuprolide can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant.
Certain brands or strengths of leuprolide are used to treat only men and should not be used in women or children. Always check your medicine to make sure you have received the correct brand and strength.
To make sure Eligard is safe for you, tell your doctor if you have ever had:
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depression, mental illness or psychosis
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heart disease, congestive heart failure, long QT syndrome
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an electrolyte imbalance or
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risk factors for bone loss .
Do not give Eligard to any child without medical advice.
Leuprolide usually causes women to stop ovulating or having menstrual periods. However, you may still be able to get pregnant. Use a condom or diaphragm with spermicide to prevent pregnancy. Leuprolide can make hormonal birth control less effective .
You should not breast-feed while using Eligard.
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Side Effects And Risks
Eligard and Lupron Depot both contain the same active drug, leuprolide acetate. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.
Mild side effects
These lists contain up to 10 of the most common mild side effects that can occur with either Eligard or Lupron Depot, as well as mild side effects that both drugs may share.
- Can occur with Eligard:
- increased risk of heart disease
Baseline Demographics And Disease Characteristics
Overall, 107 patients were enrolled at 20 centers across Asia between Q2 2017 and Q3 2018. The SAF, FAS, and PPS analysis sets comprised 106, 105, and 65 patients, respectively, with reasons for exclusion listed in Figure 2.
Figure 2
Patients in the SAF had a median age of 71.5 years, a median PSA at diagnosis of 59.6 ng/mL, and a median duration of prostate cancer of 24.8 months. The majority of patients had a clinical tumor stage of T2 or T3 , with 67.9% of patients diagnosed with stage M1 metastasis. Approximately one-fifth of patients had received prior cancer treatment, including prostatectomy , transurethral resection of the prostate , pelvic lymph node dissection , and other treatments . Similarly, 57.5% of patients received concomitant bicalutamide for flare prevention in the SAF. The baseline characteristics for the SAF are summarized in Table 1.
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How Long Will Eligard Work
Studies have shown that continuation of therapy with leuprolide acetate maintains testosterone below castrate levels for up to seven years. This effect on testosterone suppression may be reversed if the drug is stopped. But in some patients, over time, hormone therapy may no longer work to slow prostate cancer growth. If this happens, your doctor can recommend other treatment options.
What Is The Best Treatment For Enlarged Prostate 2022
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement The options include: Alpha blockers These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier.
Although there is no cure for benign prostatic hyperplasia , also known as enlarged prostate, there are many useful options for treating the problem Treatments focus on prostate growth, which is the cause of BPH symptoms.
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Recurrent Prostate Cancer Symptoms
Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes outside the prostate, it most likely develops in bones first. Metastatic prostate cancer most often spreads to the liver, bones and lungs.
After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:
- Blood in the urine
- Difficulty breathing
Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.
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How Long Does Eligard Work For
When you start treatment with Eligard, your doctor will recommend how long you should take the drug. In many cases, you may take Eligard for a long period of time.
Although Eligard doesnt work to treat advanced prostate cancer, it can help manage symptoms that the condition may cause. Studies of leuprolide acetate, the active drug in Eligard, have shown it to be effective for up to 7 years in people with prostate cancer.
Your doctor will help you determine how long you should take Eligard. Its possible they may recommend that you take Eligard as a long-term therapy.
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How Long Is Hormone Therapy After Prostate Radiation
You might have hormone therapy before, during and after radiotherapy Doctors usually recommend that you have the treatment for between 3 months and 3 years.
After completing external beam radiation therapy , urinary and bowel side effects may persist for two to six weeks, but they will improve over time You may need to continue some medications Some patients report continued, though lessening fatigue for several weeks after treatment.
Drug Forms And Strengths
Eligard is given as a subcutaneous injection by a healthcare professional. Youll receive it at your doctors office or hospital. For more information about how Eligard is given, see the How Eligard is administered section above.
Eligard is available in the following strengths: 7.5 milligrams , 22.5 mg, 30 mg, and 45 mg.
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How Long Should You Take Eligard
When you start treatment with Eligard, your doctor will recommend how long to take the drug. In many cases, you may take Eligard for a long period of time.
Although Eligard doesnt treat advanced prostate cancer, it may help manage your symptoms and decrease side effects that the cancer can cause. Clinical trials of leuprolide acetate, the active drug in Eligard, have shown it to be effective for up to 7 years in people with prostate cancer. For more on the effectiveness of Eligard, see the Eligard for prostate cancer section below.
Your doctor will help you determine how long you should take Eligard. Its possible they may recommend you take Eligard as a long-term therapy.
What Is Androgen Deprivation Therapy
GnRH agonists are often referred to as androgen deprivation therapy . These drugs work by stopping production of the male hormone testosterone in the testicles. Interrupting the supply of testosterone can help cancer cells to grow more slowly or die.
GnRH agonist therapy like Eligard can be used in advanced prostate cancer that has spread in the body to shrink and slow the growth of cancer, which may help to relieve your symptoms. Hormone therapy can be used alone or with other treatments such as chemotherapy, radiation or surgery.
Eligard is a long-acting injected suspension. It is injected under your skin once every month, or once every 3, 4 or 6 months. You and your doctor can determine the dosing schedule that works best for you. You will receive this injection in the doctors office, a clinic or in the hospital. You do not give this injection to yourself.
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Neoadjuvant And Adjuvant Hormone Therapy For Early
Hormone therapy is sometimes given in conjunction with a definitive prostate cancer treatment, such as radiation therapy, in order to improve health outcomes. When hormone therapy is given in advance of a primary treatment, its known as neoadjuvant therapy when its given during or after a primary treatment, its known as adjuvant therapy.
Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each persons individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
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Secondary Treatment Following Relapse
Hormone therapy may also be used as a secondary or salvage treatment when PSA levels rise following initial prostate cancer treatment, indicating the cancer has returned. This situation is known as biochemical recurrence. The salient points to keep in mind are that hormone therapy is most often used as a salvage treatment when PSA doubling time is less than six months, indicating that the cancer is aggressive or may have already metastasized.
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Diagnosis Of Prostate Cancer
Prostate cancer is diagnosed using a number of tests, which may include:
- Prostate-specific antigen test the prostate makes a protein called PSA. Large quantities of PSA in the blood can indicate prostate cancer or other prostate problems.
- Digital rectal examination using a gloved finger in the rectum, the doctor feels for enlargement and irregularities of the prostate.
- Biopsy six to 12 tissue samples are taken from the prostate and examined in a laboratory for the presence of cancer cells.
If prostate cancer is diagnosed, more tests may be needed to see if the cancer has spread to other areas of the body. These may include computed tomography scans, magnetic resonance imaging scans and bone scans.
Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You can also contact the Cancer Council Helpline on 13 11 20 and speak with a cancer nurse.
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Medical Versus Surgical Castration
Reducing the male sex hormone testosterone helps stop the growth of prostate cancer cells. This is done via a process known as castration, which is a type of hormone therapy that involves the removal of testicular function either surgically or medically. Surgical removal of the testicles is the simplest and the least expensive method of castration. Because it is permanent, however, it is not preferable to most patients. Medical castration, on the other hand, is done by administering medications that block testosterone production. In exchange for keeping the testes intact, doses of these drugs must be repeated regularly for an indefinite period of time to maintain castration status.
Table : Survival Benefits Of Early Treatment
An analysis of 98 men with prostate cancer that had spread to the lymph nodes, who were randomly assigned to receive immediate hormone therapy or to forgo it until the disease spread further to bones or lungs, found that early treatment saved lives.
Deaths from prostate cancer 21 Source: Lancet Oncology 2006 7:4729. PMID: 16750497.
Other studies have shown that starting hormone therapy early on increases survival times, delays cancer progression, and results in better quality of life. However, in a review of four studies involving 2,167 men with metastatic prostate cancer, the Cochrane Collaboration concluded that early hormone therapy had offered only a small overall survival advantage over deferred treatment, and cautioned that more research on the issue needs to be done.
Although debate on this issue continues, in most cases I advise my patients with metastatic disease to begin hormone treatment early on. This is particularly important for someone with spine metastases, because a bone fracture or extension of the cancer into the spinal cord area could lead to impaired mobility and even paralysis. Fortunately, this is a rare event.
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