Changing treatments?

[ARIES29]

I have been on Firmagon (Degarelix) for 6 months now & have had success with it bringing the PSA down from 18.6 to 0.7 & now the ONC wants to change to Zoladex but am worried about different side effects.

Is there any worse side effects?

[AlanMeyer]

Hello Aries29

My inexpert understanding of the situation is that Firmagon and Zoladex have very similar adverse effects from the drug itself. For each one the primary side effects are simply the effects of lowering testosterone - hot flushes, lowered sex drive, fatigue, tendency to gain weight, etc.

The primary differences in terms of effect on the patient are as follows:

Firmagon costs more than Zoladex.

Firmagon must be injected every 4 weeks, Zoladex only every 12 weeks.

Firmagon lowers testosterone immediately without a temporary increase in T ("testosterone flare") due to the stimulation of hormones that lower T by first overstimulating its production.

Firmagon may produce a lower average T level than Zoladex, but the difference should be very small and both should bring the T level down well below the threshold needed to inhibit cancer growth.

It is very common to administer Firmagon first in order to prevent the testosterone flare. If that is done, Zoladex can then be administered without causing a flare. The activity of the testes in producing T has already been suppressed by the Firmagon. In addition, switching to Zoladex reduces the cost, pain, and inconvenience of injections every 4 weeks.

If I'm right, the switch to Zoladex should cause no problems and should reduce the cost, pain, and inconvenience for the patient. HOWEVER, I would suggest PSA and T tests just before the switch and some weeks after (when the Firmagon is no longer active) to be sure that there are no surprises and that the Zoladex is working as well as the Firmagon did.

Best of luck.

Alan

[Hidden in reply to AlanMeyer]

Dear AlanMeyer! Nice to see your input. As always great advice and I say that you know mucho about this! 🙏✌️

[ARIES29 in reply to AlanMeyer]

Thanks Alan & Nal for the advice. Very well researched I might add.I am thinking the 12 week injection instead of every 4 weeks is the reason for the change, maybe the cost also? PSA last week was 0.7 so I can monitor it from there.

One point of interest to all is I was told not to change the places of pathology because their readings are different but not by much, 0.1 or 0.2.

[Hidden]

Hey Aries ! I first had a one month shot of firmagon. Then eleguard , then finally Lupron. You’re not really changing treatment just the adt change. Cutting your t out. Keep the PSA down and fly under the radar as long as possible. I’ve been flying under the wire for over 6 years. Good luck! 🍀

[ARIES29 in reply to Hidden]

Thanks Lulu, it has been 11 years for me now so I guess we will just keep peddling along...

[Hidden]

True that Senor!

[Tall_Allen]

Degarelix may have fewer cardiovascular side effects. But it's only worrisome if you have a pre-existing heart condition. Orgovyx acts in a similar way to Firmagon, but it is a daily pill.

[ARIES29 in reply to Tall_Allen]

Thanks T-A. No existing heart conditions yet & Orgovyx is not available here so looks like Zoladex every 12 weeks.

[Hidden]

Omg! 11yrs ? Wow! Peddle or get off and push if need be . Be well 🚣🚣🚣🚣

[Horse12888]

If you're a candidate for an ADT vacation, you might want to switch to relugolix, which enables very rapid T recovery when stopped.

[Magnus1964]

Why the change? If something is working stay with it.

[ARIES29 in reply to Magnus1964]

Thats what I thought also but as I have to travel a distance to the hospital every month I think they wanted to make it easier on me?Anyway I am having monthly Firmagon to day again.

[Magnus1964 in reply to ARIES29]

That's a tough trade off.

[j-o-h-n]

Take two strikes and hit to left................

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/01/2021 10:53 PM EST

[Spyder54]

I switched from monthly stomach inject of Firmagon, also at 6 months, to 3 month butt inject of Lupron inject. Much easier. My PSA has actually lowered more dramatically on Lupron. I am now at month 13 and still going lower w PSA. Mike

[ARIES29 in reply to Spyder54]

I think my immune system is down which is why I could not tolerate Lupron.It seems to me this is all about the side effects of the different drugs & about how why try to carry on a "normal" life style with this insidious disease.

[E2-Guy]

Have you thought about tE2?

[ARIES29 in reply to E2-Guy]

Hi ronronHU. I have been reading posts on your success with the tE2 patches but sadly they are not available here & can not be ordered online without a presciption from overseas chemists.Thanks for the reply.

[E2-Guy in reply to ARIES29]

It's all bs...there is no money in a $20/month DIY hormone gel and no doctor visits! Where do you live?

[ARIES29 in reply to E2-Guy]

I am here down under in Australia ronron & I have tried so many times to buy that patch but no go. GP & MO will not write a script for it because it has not been approved here for PC but you are living proof it works.

[E2-Guy in reply to ARIES29]

Mate, I should be able to send you some of the gel that I am using. Is there a way that you can find out if any of the shippers might interfere with delivering a shipment to you? I have sent it to America numerous times without a problem; however, not all shippers will accept 'gel' so I tell them that it is 'cream'. I have a number of Aussie mates here, but because of the current C-sh*t situation they are not traveling back and forth. My American friends have never had a problem when bringing it back.

Cheers,

Ron

[ARIES29 in reply to E2-Guy]

I do buy cream & vitamins from U.S. mainly without problems just using standard post or express post so it is worth a try but I need to contact you with a mailing address & send money? How to do?

[louschu]

I take the pill form of Firmagon called Orgovyx. Hot flashes are more tolerable than Lupron, etc. Could be just me.

Firmagon stops reception while Lupron stops production. If I stopped the pill my T would return in a few days.

[ARIES29 in reply to louschu]

Hi louschu. The pill form Orgovyx of firmagon is not available here & I was reading it can be a problem if you have heart issues anyway. I do not have heart problems but dont want to tempt fate.Thanks for the reply

[louschu in reply to ARIES29]

Its the other way around. The clinical trial showed it was easier on the heart

[ARIES29 in reply to louschu]

Really? Oh well Firmagon has the PSA down to 0.5 so will keep going & I have asked for Orgovyx but like the patches is not in this country.Probably money related ?

[Hidden in reply to ARIES29]

I suspect it's money related. My painful insurance company denied Orgovyx. They will pay for Lupron or Firmagon injections.

[louschu]

Hate that. Subq injections suck. Supposedly the pill form is cheaper but it costs me more. Doctors loose revenue.

[Hidden]

It's neat how they both work. Kind of opposite ways to get T to zero.

Firmagon is a GnRH receptor antagonist and Zoladex is a GnRH agonist. They get to the same end result (zero T) by overloading or damping out fluctuations in GnRH/LH.

Firmagon will slam LH to zero. So T goes to zero fast. Sometimes in a couple of days.

Zoladex takes GnRH to a constant high. T goes high at first (T flare) and then drops to zero since your body doesn't see any fluctuations (it's the fluctuations that activate LH and therefore T from the testes).

Sounds like your doc did the right thing since your PSA/cancer called out for it. Use the antagonist for a few months to get T to zero without a flare. Now your endogenous T is zero so he can switch you to an agonist and your T should stay at zero. There are other ways around it and for many guys, the flare doesn't matter (depends on the stage of cancer and mets).

Side effects are primarily due to zero T. If you use a low-dose estrogen patch (I use a Climara 0.025 mg/day weekly patch) you lose some of the bad side effects of zero hormones. But you do not affect the zero T which is how the ADT works. I discussed this with my MO and urologist to confirm this.

Zoladex: chemocare.com/chemotherapy/...

Firmagon: chemocare.com/chemotherapy/...

There are some side effect differences. Some people do better on agonists. Some on antagonists. I think that Zoladex might be easier to do since you can do a 3-month option. And I guess it might be cheaper also.

[ARIES29 in reply to Hidden]

Interesting reading RSH1. For me Firmagon works & I have two more monthly injections left when I see the MO again. He has indicated if the PSA keeps on the down trend then it will be 0 or 0.1 by then & I will go on a vacation from ADT, hopefully.I have ordered the emerita phytoestrogen cream, a dime size dollop twice day & this I hope will keep the T away & PC at bay. The pro-gest cream in 48 single use packets looks promising also.

Here^s hoping.

[Hidden in reply to ARIES29]

I'm glad to hear that things are going well. I'm going to go on Firmagon soon.

Look into cabergoline. My MO thinks that PCa loves prolactin. So caber is a nice addition for me.

Estrogen works so well. I wish it was standard of care but only a minority of doctors use it. Make sure you measure your estradiol with a sensitive test. I target 15-30 pg/ml.

Russ