Originally, after a prostatectomy and 40 radiation treatments, I had a one month shot of Lupron followed by a six month shot of Lupron. My PSA went to undetectable. Seven years later my PSA crept up to seven and I was put on a monthly shot of Firmagon for life. My PSA is again undetectable and all scans are negative, as they have always been. My question is about the effectiveness of a one month shot compared to a three and six month shot. I don't have a choice as long as I'm on Firmagon. It's given every 28 days. But with Lupron and Eligard, it can be given every one, three or six months. If I remember correctly, I don't think the six month Lupron shot was any bigger than the one month shot. So why does one last so much longer than the other? Are the side effects of a six month shot more severe than a one month shot? I guess as long as the Firmagon is working I'll stay with it but it would be nice to go through it twice a year instead of every month.
1, 3 or 6 month ADT?: Originally, after... - Advanced Prostate...
1, 3 or 6 month ADT?
• LUPRON DEPOT 7.5 mg for 1-month administration, given as a single intramuscular injection every 4 weeks.
• LUPRON DEPOT 22.5 mg for 3-month administration, given as a single intramuscular injection every 12 weeks.
• LUPRON DEPOT 30 mg for 4-month administration, given as a single intramuscular injection every 16 weeks.
• LUPRON DEPOT 45 mg for 6-month administration, given as a single intramuscular injection every 24 weeks.
Same side effects
Does 45 mg give you a huge lump?
I’ve had all of them and never noticed any lump with any of them.
You didn't have a lump in your abdomen? I've never heard of anyone who didn't.
Not with Lupron. I get the shot in my hip.
45mg is very little. Most of the volume is the carrier liquid, which is probably little different among the doses.
A six-month shot did not cause a large lump for me.
I agree the once month shot of Firmagon is a nuisance but the SE are nothing compared to Lupron, just soreness at injection site.
False. Both drugs do exactly the same thing. However, if you believe that, then placebo effect takes precedence as always.
For me the SE of Lupron & Firmagon were very different. Lupron almost knocked me out were Firmagon allows me to almost live a normal life. We are all diferent & that is how I found the two drugs.
With regard to lumps and soreness. I've always had mine in my behind. My first was given by my Ex-Uro. Huge lump and soreness for days. They came in and jabbed me quickly. I then learned on this forum - take the weight off of the leg where the injection will be and ask the nurse to take their time instead of a quick plunge. I've never had any issues since.
To state the obvious: each of us is unique (as you can read from the responses). Three 3 mo injections here. Large lump in belly lasting the duration of each injection. Annoying but not troublesome. Side effects awful for me but there is great variation among men there too. Btw, I chose 3 mos because I told myself that I could survive 3 mos of anything (aren't fantasies and self lies wonderful?) Truly, for me, ADT was a horrible experience. Hope you're luckier than I was.
EdinBaltimore
Lupron and other testosterone killing drugs have only one side effect… the lowering of testosterone. Low testosterone has a number of side effects that go from bothersome to downright aggravating. Each of us react to low testosterone in different ways and varying intensities. In my opinion (personal history one 4-month Eligard shot), the drug used to lower T doesn’t matter, because the side effects aren’t caused by the drug… they’re caused by low T.
BP- Over past eight years, I've been on Lupron, Firmagon, Zytiga (w Pred/Dex), and Zoladex for ADT. All have nearly zeroed T. However, SEs have wildly varied for me. Lupron nearly killed me with hypertension. Zytiga caused 25# weight gain (I suspect the steroids were the actual culprit). Zoladex is almost benign. My MO said they all work in different ways, so SEs might reasonably be expected to vary.
I guess my evaluation is too simplistic. I didn’t account for reactions to the various compounds that make up the overall drug formulation. I still, however, think that mostly, you will find men complaining about low T’s effects on their wellbeing.
Hubby had 1-month Lupron, stood on one leg, nurse massaged the hip as slowly going in. No lump. His treatment team switched him to 1-month Eligard, big difference, he felt terrible for a couple of days and had very sore quads following that experience. He opted for the 1-month in both cases because there are charts that show (Google them) the 1 month lasts for about 28 days, the 3-month lasts for about 2.5 months, and the 6-month fades after 5-months or so. But the biggest difference is that although the 3- and 6- months are supposed to be time-release (micro-encapsulations of the meds, in the carrier liquid) they were actually dispensing larger doses of the T-blocker early on. In other words, there was a somewhat dramatic rise in the T-blocker early on, and then the level of T-blocker fell, gradually, over time. The 1-month injection seems to be more stable, throughout the duration of 28 days.
Hubby was on a trial of Orgovyx, loved it - as much as a person can love an ADT med! - but after month 2 the trial ended and in lieu of paying $XXXX every month he grit his teeth and took an injection.
This is the first I have heard of varying amounts of t-blocker being released with the longer duration shots. Is there any documentation of this and how the side effects differ from a 30 day?
I have been on 90 day Lupron injections(that is all they had access to during Covid) for 2 years and then this summer, due to upcoming insurance changes, I opted for a 6 month injection. I thought that it was a little rougher on me the first few weeks, but I have nothing to back it up. With insurance issue resolved, I am deciding whether to go back on 3 month or to stick with the 6 month. Uro is fine with staying on 6 month. Comments?? Tall Allen?
My understanding is that the shorter doses do a better job of maintaining a constant dose.
In an analysis of four open-label studies of the leuprorelin acetate powder for reconstitution, mean serum testosterone was consistently maintained below 0.2 ng/ml from week 5 for up to 24 weeks with the 1- and 3-month doses, 32 weeks with the 4-month dose, and 48 weeks with the 6-month dose. At least 90% of patients receiving each formulation achieved and maintained a ⩽0.2 ng/ml level of testosterone suppression between 6 and 24 weeks. Similarly, in a retrospective analysis of two clinical trials, the leuprorelin acetate microsphere 4- and 6-month formulations have been shown to suppress serum testosterone to <0.2 ng/ml in 89% and 94% of patients from 4 weeks to 24 and 48 weeks, respectively
journals.sagepub.com/doi/10...
ncbi.nlm.nih.gov/pmc/articl...
My MO was after me to switch from Firmagon to 4 mo Eligard, after reading and considering the linked papers, as well as reviewing the historical comments on this site both pro and con, I agreed. No regrets so far.
I was on 4 month Eligard and I felt like I was going to die. When I switched to one month Firmagon I felt much better. My PSA was undetectable on both. Are you saying I should switch back to 4 month Eligard? I know I'll feel like garbage, but if it's better, even though I was undetectable on Firmagon, and you feel it's better, I'll do it.
Nope. You should do whatever you want and makes you happy.
I was just pointing out the longer duration formulations are effective in suppressing T consistently over the entire cycle and the effect doesn't wear off towards the end of the cycle.
So far I haven't noticed any differences se-wise between 4 mo Eligard and Firmagon. I don't have any problems with switching back if I do encounter issues.
"maintained below 0.2 ng/ml from week 5 for up to 24 weeks with the 1- and 3-month doses"
Not inconsistent with what I said.
There's 2 issues to explore here:
1. T Flare for LHRH agonist which everybody knows about and MOs plan your treatment accordingly (including starting you on Firmagon which kills T in a matter of days). That explains the 5 week part (and is a 1-time only effect when 1st start taking the drug).
2. Drug half life, the rate at which half the drug is cleared from your body. The half life for Firmagon 80 mg is 30 days (from the Mfg's abstract). So if you were to stop it would continue to work for some time past 28 days since half the drug is still in your body (I don't know what the actual number is).
For Firmagon the half life is equal to your dosage cycle so after a couple of months of treatment your drug level will eventually max out and approx. range from 2x (after you're shot) to 1x (just before your next shot) the amount of drug in the dose, consistently.
All other drugs work the same way, that is their nature and is accounted for in the dose recommendations. So the agonist drugs will also max out and degrade based on a) the dose, b) the half life and c) the dosage cycle, consistently. This explains the 24 week effect on a 12 week dose of agonist, just as Firmagon has this effect as well.
I am ignoring things like drug-drug interactions which can change the rate at which the drug is cleared, and are to be avoided in any case.
So I don't think any of these drugs are working any more or less consistently than the other. They are working the way they are designed.
Of note is that a drug with a shorter dosage cycle should clear completely - faster than a drug with a longer dosage cycle - when you stop taking it. This is of interest to people who plan to stop taking the drug at some point and is one of the reasons that people like Orgovyx which has a daily cycle.
Anyway cheers, and I'm not trying to pick a fight here.
Thanks. I've been on Firmagon for two years and my MO says I'm on it for life. My PSA has been undetectable and all scans are negative. TA said Firmagon will work until it doesn't so I guess I'll stay the course. Thanks again.
When I started ADT I originally tried Orgovyx - it was ineffective in lowering my testosterone enough after a few weeks. I was then given a 1-month Firmagon in my stomach (actually two shots leaving a small lump that subsided over the month) - then I was moved onto 6 month Lupron shots, which are given in the hip and leave no lump or discomfort. Get my last 6 month shot next Monday as I complete 2 years of ADT in late April. Just an FYI.
Me too!! Let's get through this. All my best!
I wouldn't expect different SEs, as they derive from low T.
You could consider intermittent ADT, which is not inferior to continuous.
personally the 6 month shot of lupron kicked my butt. I had fatigue from all of them but nothing like the 6 month shot. Don’t know the reason.
Have been on 6 month Lupron injections for 7 years now. It does leave a lump in the muscle for a week or so but dissipates over time. Not real comfortable but a small price to pay for being alive.
FWIW, I received ADT treatment starting in Aug 2018 for 4 full years. This included bicalutamide orally every day. For same period, I also received 3 month extended release Lupron shots every 3 months during the 4 years except during the pandemic period they substituted Eligard at least once. I think once they did a 6 months shot. I received all the shots in my upper arm - basically same location as a flu shot. All here may already know that Lupron and Eligard are actually the same drug but have a different delivery method. The Lupron shot was injected into upper arm muscle; I recall Eligard is just under the skin.
When I first got the Lupron shot, the nurse asked where I wanted it - rear, hip or stomach. I asked "why not shoulder?" She said shoulder was fine - I alternated between arms for subsequent shots
In all cases, I had no side effects from any of these. That includes nil irritation of any sort at point of the injection except for a minor irritation there at injection location for a day or so.
One thing I have noticed is that some people say they get bad side effects from Lupron and Eligard. I didn't experience any of these
I did 1-month Lupron injections on a 5-week interval after reading some studies showing the average serum concentration is lower with the one month shot, and finding that a five week interval was enough to keep my T <12. By doing this extended cycle, I only needed 15 shots instead of 18 shots for18-months of ADT, and probably had fewer SE’s as a result. Another factor is I only weigh 145 lbs, and the typical dosage for drugs is based on the average male weight of about 190lbs +/-.
You know guys......I've been praying for a front lump for years now......
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 11/20/2023 5:27PM EST
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