As part of an added supplement, we at UroToday International Journal present the following added information regarding the article "Androgen Insensitivity Syndrome: Case Report With Review of the Literature." Reponses are provided by corresponding author Dr. Bo-Eric Persson.
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Q. What does your contribution add to the present knowledge? What's essential to understand about in terms of clinical practice?
A. This paper reports the first study comparing the effect of a GnRH agonist (leuprolide) and a GnRH antagonist (degarelix) on health-related quality of life (HRQoL) in patients with prostate cancer. In clinical practice, this is an important outcome for patients, as the symptoms of prostate cancer and the side effects of long-term ADT can have an impact on HRQoL. The results of this 1-year study show that GnRH agonists and antagonists differ in terms of their impact on HRQoL. The deterioration of mental HRQoL was significantly lower in degarelix-treated patients, and treatment with leuprolide had a seemingly more favorable impact on bodily pain and insomnia (although baseline insomnia levels were significantly lower in the degarelix group). In patients with metastatic disease, several HRQoL domains were significantly improved with degarelix versus leuprolide, including global health status.
Q. Will this replace existing techniques or therapies now or in the near future? Will it impact the standard of care?
A. As well as the significant improvements in some aspect of HRQoL versus leuprolide, degarelix was also associated with other clinical benefits in the same study. Unlike leuprolide, degarelix was not associated with testosterone surges or microsurges. It reduced testosterone and PSA levels significantly faster than leuprolide, and it significantly improved PSA progression-free survival compared with the agonist. Taken together, these data suggest that GnRH antagonists may replace GnRH agonists as first-line agents for patients with prostate cancer.
Q. What are the three things that this technology does or enables that I should know to impact clinical practice? What's your take-home message for me as your colleague?
A. Degarelix is associated with a significantly lower decline of mental HRQoL compared with leuprolide in patients with prostate cancer; in addition, in those patients with metastatic disease, it offers a significant improvement in overall HRQoL versus leuprolide. Combined with its additional effects on PSA progression-free survival, the take-home message is that degarelix is an effective, first-line agent for prostate cancer, with a number of clinical benefits over GnRH agonists.