ADT CHOICES

[epfj3333]

I'm on Firmagon once a month and it's working fine. The only problem is that I feel like garbage for 2 or 3 days after the shot. Is there any difference in effectiveness if I had a 6 month shot of Lupron or Eligard?

[6357axbz]

Ive had them all and they have been equally effective. Firmagon is good to start out on as it doesn’t result in a PSA flare-up but after the first month or so switching has no adverse effect in my experience.

[ARIES29]

I have been on Firmagon for 10 months? now & found it to have the least side effects of all.Soreness at the injection site, feeling like crap for 2 days, Hot flashes, headaches is just how it is.

I could not do Lupron at all. Best to you.

[Hidden]

Firmagon is a GnRH antagonist and Lupron is an agonist. It might seem like they are 180 degrees opposed but actually, the variance in the GnRH signal is what is important. Lupron takes it to a constant high, Firmagon a constant low. Constant high results in a lot of LH and therefore testosterone before the body figures out that the signal isn't changing (and then LH and T go castrate). Constant low just results in a very fast dump of LH and T.

Firmagon is similar to Relugolix. This study might help out: clinicaltrials.gov/ct2/show...

Castrate levels are achieved faster and are steadier with Relugolix (prob Firmagon also). But overall PSA success is almost identical. Caveat: some doctors think that decreasing FSH is also important. Relugolix decreases FSH about twice as much as Lupron.

I'm going to get my first Firmagon shot in the next day or so. If it hurts then the month after I might switch to Lupron - but need to study FSH more and discuss with my MO. Or I might just get an orchiectomy (my MO thinks this is the cleanest route). I take my testosterone all over the place as part of my hormonal therapies so endogenous T is just a hassle. Right now I'm using 172 mg of Androgel a day and my testosterone is over 2000. In a week it should be zero.

[MateoBeach in reply to Hidden]

I am going to use Firmagon myself cyclically with my modified BAT cycling. 2 ( or maybe 3 Mo) high t then 1 Mo castrate levels, for now anyway. I previously did a personal trial on a single injection of Firmagon at 120 mg and followed serial T levels. I stayed at T <20 ng/dL for THREE months. It may be worth following personal dynamics after a single dose to see if it is effective for that individual to have less frequent injections, such as every two or three months.

[MateoBeach in reply to MateoBeach]

Of course, orchiectomy solves all that.

[Hidden in reply to MateoBeach]

Good info. I'll monitor and only inject as needed.

[tango65]

You could do the change to Lupron if you do not have cardiovascular problems, mainly coronary artery problems, such as angina, heart attacks , heart failure ,and also stroke or TIAs,

[maley2711 in reply to tango65]

don't huge majority of 70+ men have CV problems..diagnosed or not? why not Firmagon for all these men? assuming injections are tolerable....or alternatively Orgovyx?

[tango65 in reply to maley2711]

I do agree with you, the problem is he was not tolerating Firmagon.

[epfj3333 in reply to tango65]

I'm tolerating it OK and it's working. My only problem is fatigue when I play golf. I'm a retired touring professional, so now what I do is play with nice guys who are lousy players. It makes me feel like a superstar again!!!

[tango65 in reply to epfj3333]

Glad to know you are tolerating Firmagon OK. You will have the fatigue with any of the drugs used to produce castration.

[epfj3333 in reply to tango65]

Thanks. I'm learning to live with it.

[epfj3333 in reply to epfj3333]

It's 3 months later and I've learned to deal with the Firmagon. Still have the hot flashes and some fatigue but hand held fans really help. My golf game has returned. I can finish 18 holes with no problem. Can't play professionally anymore but still play three days a week for fun. Working out in the gym 3 or 4 days a week. When I don't play golf, I work out at the gym or do yard work (I have 3 acres of land to maintain). The Firmagon is working. PSA undetectable and all scans negative. It's Firmagon for life so I'd better get used to it!

[Vangogh1961]

I switched from firmagon after 6 months it caused a red welt for about a week after each injection. Almost nothing from the Lupron. I am meeting with urologist tomorrow, to see about removing the boys. I see limited sense in ongoing shots to chemically induce what a minor surgery will permanently fix.

[JimJimJimJim]

As someone who has been on ADT for 9 of the past 12 years, the last 6 on Firmagon, I am well versed in those first 1-2 days after the injection every 4 weeks.I have a few mates in the same position and I prepared a summary of hormone therapy options (including orchiectomy).

I am not a doctor, but here t'is:

jimjimjimjim.com/post/hormo...

[maley2711 in reply to JimJimJimJim]

Thank you...sure that will be very helpful for many men!!!

[Boonster in reply to JimJimJimJim]

JimJim, thanks very much for the extremely useful summary. I am relatively new to the ADT world, so the survey is especially welcome.

[Atlpapa in reply to JimJimJimJim]

Jim, very nice summary. The only thing I belive you got wrong is when you wrote:"Orchiectomy gives 1.4 times the number major adverse cardiovascular and cerebrovascular events (things like heart attacks and strokes) that the injections did, with stage 4 men most affected."

I believe studies show the opposite; there are less cardiovascular events with orchiectomy.

[Atlpapa in reply to Atlpapa]

More specifically orchiectomy is better than lupron/ Eligard. A GnRH antagonist like Orgovyx or Firmagon are more on par with orchiectomy.

[JimJimJimJim in reply to Atlpapa]

Thank you for paying such careful attention to my post.

It is so hard to produce a summary of very complex scientific or medical matters without putting in so much detail it is no longer a summary.

Without wishing to start one of those 'and this paper supports my side' wars, this is a very recent paper in the Journal of Urology (2021) :

pubmed.ncbi.nlm.nih.gov/348...

I have changed that section of my hormone therapy summary to read:

"The safety of orchiectomy is something you will have to depend on the skill of your doctor to work out for you. The studies reported come down on both sides, and your doctor will need to look at the studies themselves, and look for weaknesses (like whether the study used an unbalanced comparison) to decide.

But, some studies do suggest that, especially for more advanced men, or for older men, or for men with previous cardiovascular events, orchiectomy gives more major adverse cardiovascular and cerebrovascular events (things like heart attacks and strokes) that the injections."

[Atlpapa in reply to JimJimJimJim]

Jim - you've put together an excellent and very helpful article/post ( much more than a summary). I didn't mean to take away from it. Thanks for sharing the link to your summary and the link to the study it was very informative. Cheers.

[JRPnSD]

I did the Firmagon routine for 4 months and couldn't take it after that and switched to the pill version of Antagonist ADT, Relugolix. Seamless transition....so much easier than injections.

[Boonster in reply to JRPnSD]

I have found Relugolix to be quite tolerable, too.

[jjdevin in reply to JRPnSD]

I read that medicare would only cover injections and not pills. I would much prefer the Relugolix. Do you know if medicare covers Relugolix?

[JRPnSD in reply to jjdevin]

The rules apply to medications not methods of administration. Contact your provider and have them run the numbers for you.

[EdinBmore]

From my experience, they both suck (and not in a good way). Horrible side effects for me. Awful year and a half.

Suggest "Androgen Deprivation Therapy: An Essential Guide for Prostate Cancer Patients and Their Loved Ones," a good guide for what to expect and what to do about the side effects.

Question: does one get the same side effects from removing the boys as one gets from ADT?

EdinBaltimore

[Pianodude]

I was on Firmagon. I had about 5 days of injection site irritation, bit it works. Now I am on Orgovyx. It also works but there is no injection. The hot flashes, etc. are all the same.

[CalBear]

...ditto on Firmagon site soreness. It varied quite a bit from month to month but it became really annoying.. Switched to Orgovyx with no change to ADT side effects - really glad I did.

[London441]

The difference is mostly the inconvenience of the monthly injection and pain at the injection site often reported with firmagon. And of course with relugolix there’s no injection at all.

Ultimately it’s what all these drugs have in common that is the bigger issue- suppressed testosterone. Make sure to eat healthfully and less, since metabolism is slowed. Most of all exercise, including plenty of weight lifting. You will be sorry if you neglect this.

[Tommyemily]

I have been receiving monthly Firmagon injections since May 2021 and can confirm that the experience and care of the nurse giving the injection makes an enormous difference in the pain during and after the injection. An elderly caring nurse always insisted that I lay on my back with bended knees whilst she injected me on the side of my belly (sub-cutaneous) and changing sides each month. This certainly made a difference, as the injection could hardly be felt and the slight pain at the injection site soon disappeared within 48 hours. Try to avoid being the pincushion of young inexperienced nurses, pretty though they may be !!

The trick in the bended knees is that it eases your stomach muscle tension.

[Seasid]

Are they inserting the needle fully? I just cout a nurse that she is not inserting the needle fully. I asked her why not and she said because it is a subcutaneous injection. That is rubbish. It should go deep into the fat tissue. I am amazed. Wow. They don't have a clue and they don't care. I said that it will be more painful. She didn't care. I can't simply stop getting the injection, so I have to live with the pain and redness.

[epfj3333]

Update. I've been on Firmagon for about a year now and the side effects are not as bad. I still get the hot flashes and fatigue but I carry a pocket fan and a small wash cloth and I've just learned to live with it. The Firmagon is working so I can put up with the inconveniences.