What would be the next step if a patient’s serum testosterone remains above 40 several weeks after the initial dose of a GnRH agent in the treatment of prostate cancer?

Real-world data show that approximately 3-7% of patients experience breakthroughs above 40 ng/dL per patient course, while 6.6% experience breakthroughs above 32 ng/mL (1.1 nmol/L). When using the lower threshold of 20 ng/dL (0.7 nmol/L), breakthrough rates increase to approximately 41%. One large r...

Agree with Dr. @Dr. First Last. My simplified approach:

• Testosterone is repeatedly above goal: switch to an LHRH antagonist (I find relugolix convenient).
• Testosterone is above goal towards the end of the LHRH agonist dosing interval: in this case, the treatment is not lasting long enough. You can ...