Prostate Cancer
The most common non-skin cancer in men. Hormone-sensitive prostate cancer is treated with androgen deprivation using GnRH agonists (goserelin, leuprolide, triptorelin, histrelin) or antagonists (degarelix, relugolix). These represent among the highest-volume peptide drug prescribing globally.
Technical Context
Most common non-skin cancer in men (approximately 1.4 million new cases globally per year). Androgen deprivation therapy (ADT) is the foundation of treatment for advanced/metastatic disease: GnRH agonists (goserelin — SC implant 1 or 3 months; leuprolide — IM/SC depot 1, 3, 4, or 6 months; triptorelin — IM depot 1, 3, or 6 months; histrelin — SC implant 12 months) achieve castrate testosterone (<50 ng/dL) via GnRH receptor downregulation. GnRH antagonists (degarelix — SC injection monthly; relugolix — oral tablet daily) achieve castration without flare. Choice factors: agonist flare risk (avoid in spinal cord compression, urethral obstruction — use antagonist or add anti-androgen cover), convenience (histrelin implant = annual; leuprolide 6-month depot vs degarelix monthly), and oral availability (relugolix — the only oral GnRH antagonist for prostate cancer). ADT is combined with: novel androgen receptor pathway inhibitors (enzalutamide, abiraterone, darolutamide, apalutamide) and docetaxel for metastatic disease; radiation for localised/locally advanced disease.