Steroidal antiandrogen administration to treat gonadotropin-releasing hormone analogue-induced orchialgia

To describe a case of gonadotropin-releasing hormone (GnRH) analogue-induced orchialgia and to outline a novel treatment for this debilitating adverse effect. In this case report, we describe the clinical, laboratory, and imaging findings of the study patient and describe the treatment approach. After 15 months of treatment with a GnRH analogue (goserelin acetate), a 76-year-old man with prostate cancer that had been treated with standard therapy presented with bilateral testicular pain that was refractory to simple analgesics. It was not possible to discern an etiology for the orchialgia from his history, and he had received no new prescription medications. On physical examination, he had no evidence of skin rash, inflammation, or abnormalities of the testes, although there was marked tenderness on palpation. Findings from testicular ultrasonography were unremarkable and confirmed normal anatomy and blood flow. His prostate-specific antigen nadir was satisfactory at 0.1 ng/mL, indicating a strong, persistent biochemical response to combined hormonal blockade and radiation therapy. The use of a steroidal antiandrogen (cyproterone acetate) effectively abated the reported testicular pain. The use of GnRH analogues in the endocrine management of prostate cancer is becoming more widespread, and clinicians should be aware of orchialgia as a rare adverse effect. This is the first reported case of testicular pain in association with goserelin acetate, and we conclude that cyproterone acetate may have a useful role in managing this condition.