Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.

中文翻译：

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评估促黄体激素释放激素 (LHRH) 激动剂 (戈舍瑞林) 和 LHRH 拮抗剂 (地加瑞克) 疗效和安全性差异的临床证据综述。

促黄体激素释放激素激动剂 (LHRH-A) 戈舍瑞林和拮抗剂地加瑞克均适用于治疗晚期前列腺癌 (PCa)；然而，缺乏评估其有效性和安全性的大型比较试验。在这篇综述中，我们评估了这两种药物的现有证据。尽管地加瑞克实现了睾酮 (T) 和前列腺特异性抗原 (PSA) 水平的早期快速下降，但除前列腺体积和国际前列腺症状评分外，中位 T 和 PSA 水平在剩余治疗期间与戈舍瑞林相当。地加瑞克不会引起初始发作，因此推荐用于脊柱转移瘤或输尿管梗阻的患者。戈舍瑞林可降低 PSA，缩短进展时间，与单独放疗相比，在放疗的辅助下给予更好的生存结果，即使在长期随访中也有显着的结果。支持地加瑞克辅助使用的证据有限。与地加瑞克相比，戈舍瑞林具有更好的注射部位安全性、单步给药和高效的给药方案，而地加瑞克具有显着更高的注射部位反应和较低的给药机制。关于心血管疾病 (CVD) 的风险存在相互矛盾的证据，在已存在 CVD 的患者中使用 LHRH-A 时需要谨慎。有相当多的长期证据表明戈舍瑞林可用于晚期 PCa 患者，地加瑞克是较新的选择。