Is disease flare a problem?

When given for the first time to previously untreated patients with advanced prostate cancer, luteinizing hormone-releasing hormone (LHRH) analogs induce a transient rise in pituitary luteinizing hormone levels. As a consequence of this increase of LH, there is, within the first 2 to 3 days, a surge of testosterone, which can cause an exacerbation of the symptoms. First reports concerning this flare have been anecdotal, and in most studies, flare is reported with an incidence of 4-33%. This variance is due mainly to the confusion about the definition of the flare phenomenon. No distinctions have been made between clinical flare, with its manifestations of subjective or objective aggravation of cancer related symptoms, and the biochemical flare that results of the LHRH analog administration and that occurs in a majority of patients and is characterized by increases in testosterone, prostatic acid phosphatase, and prostate specific antigen. As the possible interference of the flare phenomenon on the ultimate aftermath of the patient's response to therapy is not yet known, it seems mandatory that flare prevention should be carried out whenever LHRH analogs are prescribed in monotherapy.