Abstract
Androgen deprivation therapy for advanced prostate cancer has traditionally relied on luteinizing hormone-releasing hormone antagonists (LHRH). However, newer oral gonadotropin hormone-releasing hormone antagonists (GnRH) offer faster responses and fewer adverse effects. A 65-year-old male diabetic patient with a history of lower urinary tract symptoms and an indwelling Foley catheter for two weeks presented with respiratory difficulty, bilateral lower limb swelling, and decreased urine output. The investigation was suggestive of locally advanced prostate cancer with obstructive uropathy along with acute or chronic kidney disease. The patient was admitted to the ICU and stabilized. An urgent bedside prostate biopsy was performed. Relugolix 360 mg orally was given on the first day followed by 120 mg daily before histopathological confirmation due to impending oliguria and progressive kidney injury. Subsequent follow-up demonstrated clinical improvements, including reduced PSA and testosterone levels, confirming the efficacy of relugolix in managing advanced prostate cancer. Timely intervention and therapeutic adherence are crucial for optimal outcomes. Additionally, it highlights the preference for LHRH agonists in emergencies and the potential of oral GnRH antagonists like relugolix in prostate cancer management.