I'm on Degarelix/Firmagon for a year as part of triplet therapy for my mHSPC. I want to stay on this monthly injection because I prefer the "agonist" vs the alternative via Lupron etc.
I also walk briskly everyday with significant running segments on my route.
I just in the least few days have my new Degarelix depot in my stomach - and I noticed the depot was bouncing up and down when I run. I continued to run but used one hand to gently hold on my stomach over the depot and then I could feel that it wasn't bouncing up and down anymore.
QUESTION: Is anyone aware that the stomach subcutaneous Degarelix drug depot could be affected by jostling?
There are lots of reasons why after a while people become castrate resistant. In the case of someone who runs maybe the jostling of the drug depot causes the Degarelix store to be released more quickly. And this might especially be true at the beginning of the 28-day cycle when the depot is much heavier.
If this is true, then the level of the drug in my system won't be maintained at target levels. And this might be "advantage cancer". And I'll never know!
So far I have not been able to find any research on this. Of course the nurses all say they don't want to make the depot under the belt or anything. But it's never clear if this is just so I'm not inconvenienced or bothered - or if there's a deeper medical reason.
I'm sure there are other people out there on Firmagon/Degarelix who exercise. This could be a worthwhile question for lots of people.
Super thanks for ideas - especially pointing to any investigation or research or knowledgeable authorities.
John
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JohnInTheMiddle
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Thanks TA. I tried to do some reading but didn't find anything directly answering my question. Do you have any pointers to something talking about this?
It's broken into active peptides by pepsidases in the liver. If you want to understand how our body's use it, you can talk to biochemists at the manufacturer.
Thanks TA. I have a little awareness of how it works, probably enough for now, which shows up in my preference for Firmagon as an androgen antagonist.
However my interest here is focusing more on the "gel" slow release technology. It's patented and kind of amazing. It has a longer name which I saw once and now can't find again. But specifically I'm concerned that agitation (I can feel the bolus or depot moving up and down on my stomach as I run) might mechanically accelerate depot ablation or absorption into capillaries of stomach fat - so that instead of lasting for 28 days more or less I'm getting a higher dose now and it kind of runs out say in 20 days. Lots of chemical reactions of course are enhanced by kinetics. ) And we even have the word "pharmacokinetics".)
the easiest solution to calm your worries would be to draw blood at the same day in the morning (or day before the injection) prior the injection to test testosterone level and confirm that it is on castrate level 🤷♂️
That's pretty cool, CSEO - in fact I always have a blood draw every 28 days about 1 hour before the Firmagon injection. But it's only for PSA, electrolytes and other markers associated with Abiraterone etc.(Then it takes 5 days to get the results oddly enough.) But no testosterone, ever.
So this raises two questions:
1) Testosterone: I am always assuming that the PSA is a good proxy for testosterone. And the PSA now after it reached nadir last October has been "zero" ever since. I'm not sure what the reason would be that I could give the MO or why we should do a testosterone test.
2) Firmagon: I think what we're suggesting here is to measure the serum blood level of the drug at the end of a cycle. And see if it has declined more than one would expect. I've never heard that anybody ever does that.
Don't worry about serum blood levels of degarelix. Just test your testosterone levels before the injection. The effect on testosterone levels is more important than the serum levels of the degarelix. I on it for more than 5 years. István
I think (that is my personal opinion and I think some trials are ongoing regarding this) only Abirateton, even if you don’t receive Firmagon injections at all would keep your testosterone at a castrate level.
1. There is no logical reason to test for testosterone in your situation … except your peace of mind, so if your MO thinks that your peace of mind is important part in your treatment - he might be willing to add inexpensive total testosterone test to your usual blood tests and find “logical” explanation for insurance. Otherwise you can pay it out of pocket and do a blood draw for it one day before Firmagon injection.
2. I think it would be excessive and I’m not sure regular labs can do such tests.
I think you are doing great results wise on your treatment protocol and there is no need to worry and look for what could possible go wrong, when everything is alright 😉
P.S. you can also consider and discuss with your MO to take Orgovyx instead of Firmagon to avoid injection pain and worries.
I'm up here in Canada and so we have single payer insurance and I'm on triplet therapy. For the reasons you mentioned and also because it is an oral androgen antagonist (as opposed to Eligard/Lupron, an agonist) I'm very interested in Relugolix/Orgovyx. But it is not approved yet here. And also compared to injectable ADT options Orgovyx is crazy expensive.
Nevertheless if I had a choice I would go with it because of the CVD advantages, the oral advantage and no injections, and the fact that its test results are excellent. I'm sure Orgovyx will be approved here eventually; it's under review now.
in Canada when Orgovyx will be approved, it would be much cheaper than in the US. Example in Austria it is 308 euros per bottle, when in the US is $2k+
Good luck with your treatments and don’t look for something extra to worry about, when there is nothing to worry.
Thank you CSEO thoughtful and kind comments. As for worrying, I shouldn't do that. But not worrying and being happy is how I got into this situation and the first place. And also trusting my doctor who is one of those lazy doctors who was prejudiced against PSA testing. You can see my earlier and very popular detailed post how about starting with a backache. And the first time diagnosis with high volume metastatic prostate cancer. Along with a lot of other men now who are diagnosed for the first time with already metastasized cancer. It's a scandal and a crime. In the meantime though let's all have a really great day. We still have one child in high school!
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