Firmagon or Zoladex....?

[blueeyes74]

Hi, hope you are all doing well, been a while since I posted but circumstances have changed and I was wondering if anyone could help with some questions I have...

We have returned to UK from Kenya and in Kenya my husbands insurance paid for him to have treatment in India, and his plan for the last two years has been monthly firmagon and daily casodex, which has kept his psa at less than 0 for the past 18 months ( after initial chemo then tomotherapy then cyber knife).

Having seen the oncologist here today he seems to prefer my husband goes to Zoladex injections and comes off the firmagon, saying that they do the same thing.... Does anyone have any feelings or experience about this? I have a feeling it could be because the NHS are saying no to firmagon because of its cost, but am worried Zoladex will not be as effective?

He also questioned the monthly injections of xgeva, but I also thought they were essential when on a drug such as firmagon or Zoladex?

I suppose I am concerned about any change as we seem to be under control at the moment and wonder if a change in drug could bring about a change in my husbands condition....

Any opinions would be gratefully received! Thanks so much to you all, and keep fighting and keep positive always 😊

X

[RyderLake2]

Hello,

Firmagon and Zoladex are like Pepsi and Coke. They both have their advocates (and a few detractors). One is an agonist and the other one is an antagonist. As you know, Firmagon (degarelix) requires monthly injections whereas with Zoladex (goserelin) you only require a shot once every three months. The Firmagon injection, if not done correctly, can result in a painful swelling at the injection site. It goes away after a few days. You probably know that as well. The Firmagon advocates including Dr. "Snuffy" Myers (now retired) felt Firmagon was superior and switched most of his patients over to this drug. I have been on both and I much prefer Zoladex. It doesn't require as many visits to the doctor. It is very effective at lowering testosterone. Xgeva aka Prolia (denosumab) is a bone strengthening drug. I am on this as well but on a maintenance dose which requires a shot once every six months. Hope that helps!

[blueeyes74 in reply to RyderLake2]

Many thanks for this. My husband has had a couple of bad reactions to the firmagon injections so I am sure he would also be pleased to have an injection less often....! Did you suffer any bad side effects with Zoladex?

[RyderLake2 in reply to blueeyes74]

Hello,

Other than the occasional hot flash and over a long period loss of libido, loss of all body hair (but not on my head) and some brain fog. Nothing I can’t handle. It probably would be more serious if I was younger. I am 74.

[Tall_Allen]

The biggest reason to switch to Zoladex is for the convenience of multi-month injections. Firmagon may be easier on the cardiovascular system. But for most men, in won't make a difference. If he is on lifetime continuous ADT, an orchiectomy may be a good idea.

He should have a DEXA scan for bone mineral density before starting on Xgeva. If he does running and/or weight training, he may not need it.

[blueeyes74 in reply to Tall_Allen]

Thanks alot for this, if there may not be a huge difference between them then it seems the ' best' one to go for would be the Zoladex, fewer injections is definitely appealing!

My husband does walk or jog so I think we may go the bone scan to see if monthly xgeva is also still necessary. Best wishes

[chipler in reply to blueeyes74]

Other recommendations from MO specializing only in prostate cancer is Xgiva every 3 months.

I do have a DEXA showing osteoporosis / osteopenia so there is reason to take it.

I also believe that there is some bone protective aspect that slows bone mets.

As for Firmaron, I had 3 weeks of hot, tender, itchy and swollen area on my belly the size of both hands. No fun. Turns out the shot was not given deep enough to be under the fat layer.

Also, changing to Lupron quarterly is far better as you only return to cancer thoughts every 90 days vs every 30 days.

That also coincides with quarterly Xgiva.

[blueeyes74 in reply to chipler]

Thanks so much, the longer we can be without cancer thoughts is definitely better!

[hansjd]

Hi blueeyrs74

My husband was diagnosed Feb 2018 and was immediately put on Firmagon (an antagonist). He stayed on that, with monthly injections, for 8 months. Then his MO, at that time, switched him to Diphereline (an agonist) with 3 monthly shots. My husband had no problem with the monthly Firmagon shots. The key is to do them very slowly, both the injection and the withdrawal of the needle. And we were happy with the drop in PSA he had with the Firmagon and chemo, so we questioned why the switch. He couldn’t give us a clear answer, just said that’s what he normally did and that they were “the same”. So rather reluctantly he switched. He was on Diphereline for 9 months (3 injections). Yes that was somewhat more convenient, but we continued to research both medications and to ask questions about which was better.

We found a number of studies that indicated that an antagonist I.e. Firmagon was better than an agonist. So 2 months ago my husband asked to switch back to Firmagon, which his current MO was happy to do when we explained why. Incidently he normally put his PC patients on Goserelin, but he is now considering the research we gave him and I think he may change his protocol.

Tall Alan mentioned the cardio vascular benefit of Firmagon which has been proven, although that is mostly for those with existing CVD. For us one of the main benefits was the fact that Firmagon is much more effective in lowering FSH (follicle stimulating hormone) which has been shown to be a good thing for PC.

There have been studies done comparing the efficacy of Firmagon to different agonists and it seems that Firmagon has a better track record especially over time. One study was a 5 year long comparison.

I would give you links to these various studies for you to consider before switching to Zoladex, but unfortunately at the moment we are travelling for a few months in Africa (currently in Zimbabwe - just read Mugabe died) and don’t have access to the links here. I suggest you Google comparative studies, the 5 year study and also FSH and PC.

As an aside my husband is doing the injections himself while we are away and reckons he does them better than anyone : ) All the best

[blueeyes74 in reply to hansjd]

Hi, thanks so much for your reply and I hope you are enjoying Africa - it is a wonderful continent and we had many happy years in Kenya.

We will definitely look at some of the studies you mention, it is important to try and stay informed during this battle! Best wishes to you and your husband X

[Rottney]

I can comment on Xgeva, both plus and minus. I was stage 4 with mets in hip and pelvis as well a lymph node in the pelvic area. My treatment has been Lupron/Xgeva, then Lupron/Xgeva/casodex after a year. I continued to take monthly Xgeva shots for two years and the mets became undetectable. PSA dropped from high of 93 to nearly 0, without radiation or RP. Pain in hip subsided as well. However I developed one of the nasty side effects of prolonged Xgeva use - osteonecrosis of the jaw. This was either triggered by, or misinterpreted as, a need for a root canal in a rear molar. It took at least 6 months to get a proper diagnosis of that condition, which could not be treated locally. It took a number of trips to UofMichigan Dental Surgery and about 18 months to get it cured, fortunately for me, without surgery.

[blueeyes74 in reply to Rottney]

Hi Rottney, thanks so much for your reply. My husbands mets in his rib are now undetectable, so maybe it is time for him to go to either 3 or 6 monthly shits of xgeva instead of monthly if it may help avoid such side effects... Keep strong 😊