Will GnRH antagonists improve prostate cancer treatment?

Androgen ablation forms a basis for treating prostate cancer and is achieved either by surgical castration, or pharmacologically using oestrogens, anti-androgens and/or gonadotropin-releasing hormone (GnRH) analogues. GnRH antagonists (or blockers) offer a new means of treatment by directly blocking GnRH receptors. Advantages of GnRH antagonists include lack of the initial stimulation of gonadotropin and testosterone production, lack of gonadotropin microsurges and sustained follicle-stimulating hormone suppression; disadvantages include increased histamine release. This review discusses advantages and disadvantages of the GnRH antagonists currently in development, in light of receptor physiology and pre-clinical and clinical data. Comparative clinical trials will ultimately establish their efficacy in comparison to other pharmacotherapies. Therefore, continuing development and refinement is needed to improve prostate cancer treatment.