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This is a combination androgen-deprivation therapy regimen comprising the GnRH antagonist degarelix acetate and the GnRH agonist leuprolide acetate, used sequentially or concomitantly in clinical practice for prostate cancer to achieve rapid testosterone suppression without initial flare (via degarelix) and then continue maintenance suppression with an agonist depot (leuprolide). Degarelix is a competitive gonadotropin-releasing hormone receptor antagonist that rapidly reduces LH and FSH, leading to castrate testosterone levels within days and avoids the testosterone surge seen with GnRH agonists. Leuprolide is a GnRH receptor agonist that initially stimulates LH/FSH causing a transient testosterone surge, followed by receptor downregulation and sustained suppression with depot dosing. Clinical literature describes initiating ADT with degarelix followed by leuprolide to eliminate or minimize the testosterone surge associated with starting an agonist, supporting this combination strategy in advanced prostate cancer.
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