Sir, - I would like some clarification of the following situation. The depot LHRH analogues goserelin and leuprorelin are used in advanced prostate cancer to produce a medical orchidectomy. Additional drugs, the anti-androgens flutamide and bicalutamide may only be prescribed in conjunction with one of the LHRH analogues. This is taken literally, even if a man had undergone earlier bilateral surgical castration. The LHRH analogue is entirely wasted in this setting, which at a cost of $1150 for 3 months seems particularly absurd. I do note that a related drug nilutamide can be used in conjunction with surgical orchidectomy, and wonder why this does not apply to the other two.
Associate Professor Gillian Duchesne
Peter MacCallum Cancer Institute
University of Melbourne
Melbourne, Vic.