flutamide + leuprolide + goserelin

This is a combination therapy consisting of three drugs—flutamide, leuprolide, and goserelin—used primarily in the management of advanced or metastatic prostate cancer. Flutamide is a nonsteroidal antiandrogen that blocks androgen receptors, thereby inhibiting the action of testosterone and dihydrotestosterone on prostate cancer cells. Leuprolide and goserelin are both gonadotropin-releasing hormone (GnRH) agonists (also known as luteinizing hormone-releasing hormone [LHRH] agonists). These agents initially stimulate but then downregulate GnRH receptors in the pituitary gland, leading to decreased secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which results in reduced production of testosterone by the testes. The combination aims to achieve maximal androgen blockade by suppressing testicular androgen production with GnRH agonists while simultaneously blocking residual androgen activity at the receptor level with flutamide[2][4][5][7]. This approach is sometimes referred to as combined or maximal androgen blockade.