After the first two or three Firmagon shots it was recommended that my husband switch to three month Lupron shots for convenience. I had read Firmagon (an antagonist) was a superior drug so we requested he be kept on Firmagon. The injection site discomfort was really only bad the first couple of times and while a monthly shot is inconvenient it's not a big deal. The more I read the more convinced I am we made the right choice.
Dr. Tom Keane: I think there is, and if there isn't, there certainly should be because I do believe not all LHRH agonists are the same, and certainly an antagonist and an agonist are completely different agents. They have been used as the same agent, but I do not believe they're the same at all. I also don't like when I hear of patients who get started on the antagonist straight away because they get castrated quicker and then converted over to the agonist. Because as CS21 showed, that's going to complete reverse from what the data shows. It was a secondary endpoint. It wasn't a primary endpoint, but once again, there was a difference in how the patients did.
And one other thing that needs to be highlighted is that when, again, this was I believe a study by Albertson where they looked at the death rates for patients in the first year, and there is a distinct difference between the death rates for patients who are on the antagonist as opposed to the agonist. These patients weren't dying of advanced disease. These were newly diagnosed metastatic disease patients who were going on ADT for the first time. As you and I both know, very few patients die within a year of disease.
Dr. Tom Keane: I would say that it's also interesting to see that a lot more medical oncologists now are involved in ADT than there used to be. The people who really did the ADT were the urologists, and a lot of urologists still think of ADT as just render them down to 50. We've got to get the message out there that 50, while it may be acceptable to the FDA, should not be acceptable to us.
And I think the medical oncology people understand that. I think the urology people need to understand that, but we're the people who usually end up giving the ADT first, at least outside of the academic medical centers. It tends to be the private practice urologists, and there's absolutely nothing wrong with that because the urologists have been treating prostate cancer for years, but I do think they need to be aware of the differences between the compounds.
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Contrary to many "Darwinian" postings I've seen on this site recently, CS21A joins a growing list of randomized clinical trials showing that reducing the cancer load as quickly and thoroughly as possible maximizes benefit. I'm not at all sure, however, that Firmagon is better than a GnRH agonist combined with an anti-androgen (like Casodex). There were rumors of a multi-month Firmagon injection.
I received an email from this site asking that I comment on your post regarding my experience with Firmagon, so here goes... I was diagnosed with Gleason 8 T4M0N0 PCa in February 2009. My urologist put me on leuprolide—not Lupron—an implant called Vantas, with a 1-year release cycle. At the one-year mark, it had not brought my T to below 30 ng/dl so my doc switched to Firmagon in February 2010, the year it first became available. It decreased my T to about 13 ng/dl within a month. While I experienced minor injection site reaction for a few hours each month, the only other SEs were the usual ones, most notably hot flashes—which result from castrate levels of T, not from the drug itself. I remained on monthly Firmagon injections until February 2012, when we discontinued ADT altogether. Firmagon was immensely successful in keeping my T under 15 for the entire period of treatment. Together with 79 grays of EBRT, my PSA has been undetectable since then. In other words, no evidence of disease 10 years on.
However, 10 years later I am still basically castrate—my latest T test (taken yesterday) is 43 ng/dl. Was this an after effect of Firmagon? I really don't think so. As with my stable PSA of 1.52 at diagnosis, my PCa has pretty much been a corner case. That I'm still castrate 10 years later appears to be another corner. As the saying goes, "individual results may vary."
Hope this helps—and good luck. There have been enormous advances in PCa treatment in the last 10 years.
Thank you so much for your response! And thanks also to whoever messaged you to request your input.
Your experience is impressive and gives me a lot of hope. I do of course understand there are as many experiences as there are individuals with a diagnosis. It is so very helpful to hear from people who have had success with their treatment plan and also from those who have had a different maybe less positive responses to treatment(s). I have learned so much from this forum and those who generously share their experience.
We just got back from my husband’s appointment where he received his 9th Firmagon shot. I confirmed with the doctor they’re happy to continue with Firmagon if that’s my husband’s preference. I also asked the nurse if they always order a testosterone check along with the PSA and she said she does it for us because she knows we want it. We will have results tomorrow. Hopefully this will be his fourth “undetectable” result. He was at 0.02 for two months then last month was at 0.01.
We are going for scans in about ten days then will make the decision on whether to add Zytiga and prednisone. The waiting and wondering is difficult.
Thank you again for your input. I really appreciate it. Firmagon feels like the right choice for my husband right now. My husband really is doing well with side effects and is bothered most by feelings of brain fog that comes and goes. We are doing well and he’s taking lots of good supppements which we believe help a lot.
My best to you and to your continued success. Thanks again for sharing your experience!
I'm a 70+ older male had prostate cancer about 5 yrs. ago After radiation I was given two yrs. worth Lupron Depot shot's I have always been straight NEVER a gay male on male thought .Now after two yrs. on Lupron I have changed .NO man wants to admit this !! So I'm sayn' it has happened to me.
To Santafeman: I'm happy to admit it. If we ever needed proof that testosterone drives male libido, i.e, that we guys are just as "hormone driven" as we think women are, it is ADT, which annihilates libido to the point that we don't even care about the absence of a sexual drive. It's not a "side effect,” it’s a “major effect!”
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