Urologist Wants to switch from Firmagon & Nubeqa to Lupron with Nubeqa

[Rcole727]

The urologist started with first injection of Firmagon with Nubeqa and before the end of 28 days wants to switch from Firmagon to Lupron with Nubeqa. I was under impression that Firmagon is better at getting the job done than Lupron? Why switch?

[Derf4223]

@Rcole727 Your bio has no case details. Suggest you put more meat on that bone.

As for your posting,

1, Do you have advanced PCa? If so you are wasting your time with just a urologist. Most folks on this site have both a Medical Oncologist and Radiation Oncologist.

2, You absolutely must read up on trials relevant to your case. LATITUDE, CHARTED, PEACE-1 .. PEACE-3, etc. Jot down key findings and questions relevant to your case and discuss with your MO or RO. If you don't they are likely to treat you like a dodderer or google-head. Use their language and cite trials and the quality of conversations will be exponentially higher.

3, If not exercising the right way in the right quantities, start today. Lots of info on that topic on this site.

[Rcole727 in reply to Derf4223]

Yes,, diagnosed with Mets in Bone and pelvic lymph nodes. 73 yrs old in good health. I have an MO who ordered Germline Braca testing and prescribed Nubeqa.

[Rcole727 in reply to Rcole727]

Also no Radiation Oncologist as I was treated in 2009 with Proton radiation at MD Anderson.

[Tall_Allen]

Firmagon and Lupron do the same thing - they stop you producing testosterone.

[Rcole727 in reply to Tall_Allen]

Isn't Firmagon a better drug doing the same thing as Lupron, but without cardiac issues that can be found using Lupron? I mention this because I had an aortic valve and root replacement 2 years ago and am concerned.

[Tall_Allen in reply to Rcole727]

Possibly - worth consulting with a cardiologist.

[Rcole727 in reply to Tall_Allen]

Thats what Im doing.

[JohnInTheMiddle]

Your urologist is probably recommending Lupron because it's more convenient. You can go 3 months are you in 6 months between injections. A few days ago I just had my usual 28-day Firmagon injection. Not too bad.

And as TA mentioned, they do of course do the same thing. I like to highlight though that they do it in a slightly different way. Lupron is an "agonist", for whatever needs to be agonized 😂. Whereas Firmagon is a different injectable technology; it is an "antagonist" of the same thing. I turned down the opportunity to "switch for convenience", based on reading a lot of things that kind of hinted at the same thing that you are suggesting. There probably isn't a gold standard of evidence yet.

[Rcole727 in reply to JohnInTheMiddle]

Thanks for your insights. Cost is probably a factor, too.

[JohnInTheMiddle in reply to Rcole727]

That's an interesting question Rcole. I was thinking you were suggesting that Lupron was less expensive. But a quick check shows the opposite. Firmagon apparently works out to be overall less expensive per month than Lupron. I didn't check the generic versions.

[Rcole727 in reply to JohnInTheMiddle]

I am surprised. I was thinking it was a newer therefore more expensive drug like Nubeqa which retails for 1 year supply $15k+/year.

[JohnInTheMiddle]

OK ADT (in our discussion here Lupron and Firmagon) has been around for decades. Lupron was apparently introduced in 1985. They're the basic backbone of PCa testosterone suppression. Most of us get ADT, and many of us forever. Then to get full-on doublet therapy you had things like Nubeqa (Darolutamide), which as you point out are crazy expensive. You could say ADT is kind of boring 😃