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Which is better? Lupron or Firmagon

PA_grandma
Posts: 48
Joined: Oct 2010

My husband will get his second Firmagon hormone injection treatment today. He wants to switch to Lupron because it won't be every 28 days.

Please help with this decision.
Joyce

tarhoosier
Posts: 182
Joined: Aug 2006

This is a question for the oncologist/urologist.
Firmagon/Degarelix is chosen for a swift and certain suppression of testosterone. It is best indicated in situations where immediate response without a flare of testosterone is necessary. For example, men with established or suspected distant metastases. T flare sometimes occurs with LHRH drugs which swamp the system with testosterone activating hormones before the body reacts by ignoring all messages from the pituitary.
LHRH drugs, and there are several which act in similar methods, can be administered once per month, 2 months, 3 months, or six months. There is also a match sized implant placed in the inside upper arm which can work for 12 months (Vantas). If his testosterone is measured and found at a low level he may switch to whichever of these his doctor recommends.
No matter which drug is used, the testosterone must be measured to determine if the drug is working adequately. This is often overlooked and can identify a doctor providing the proper care

PA_grandma
Posts: 48
Joined: Oct 2010

Thanks for your reply, tarhoosier.
My husband saw the Urologist yesterday and had his second monthly Firmagon injection. He discussed making a change to Lupron... and she agreed. The first PSA test since starting hormone therapy was done. We won't know the results for a few days.

The Lupron next month will be the only treatment for his Prostate at this time until the chemo for Hodgkin's lymphoma is completed. ~ Joyce

ob66
Posts: 215
Joined: Apr 2010

I have not had firmagon injections. I am on my second 4 month lupron injection. I would stay with lupron and not even consider some 1 month solution. I will take hot flashes over the alternative any day. Right now I have RT(post daVinci surgery), plus lupron, and a Meditteranean diet all working in my body to fight the growth of CA cells. I went to my MD on Monday and almost made a case for more lupron so the other two could work their magic as much as possible while the testosterone was not allowed to feed the CA cells. JMHO.

PA_grandma
Posts: 48
Joined: Oct 2010

ob66, good to hear about your decisions. Firmagon has hot flashes too, as well as night sweats....and etc. etc. I guess all treatments have their side effects.

We will see next month when John switches from Firmagon to Lupron if they are any different. Extending the time frame for injections will be a help. ~ Joyce

VascodaGama's picture
VascodaGama
Posts: 1548
Joined: Nov 2010

Hi Joyce
I have answer to your question on another forum. Unfortunatly my reply was edited due to restriction on that site. In this ACS Forum there is a thread under the name "Firmagon (Degarelix) substitute for Lupron", which I recommend you to read. It gives you an idea of the difference between drugs, and the experience of some that have switched them.

Wishing you the best.

MichaelJ62
Posts: 1
Joined: Nov 2010

I was on a quarterly Lupron shot for three years & had no problems.

PA_grandma
Posts: 48
Joined: Oct 2010

Michael: Thanks for sharing your experience with Lupron
Vascoda: (Yes, I noticed the edit.) I'm going now to read the site you mentioned, appreciate the second effort ~ Joyce

p.s.
Vascoda.... as I read the site it sounded familiar. Yes, been there - done that. Even posted a question in October. It was good to read it again, tho... and everyone is different. John (my husband) has had NO pain at injection with Firmagon. So the main concern I now have is - the initial flare with Lupron and the need for Casodex.

VascodaGama's picture
VascodaGama
Posts: 1548
Joined: Nov 2010

Hi Joyce
Surely Lupron will cause flare for about two weeks, which is no good for patients with metastasis particular in the lower spine. But there will be no problem or particular side effect of taking Casodex (bicalutamide) for 10 days before the Lupron. There is still another anti adrogen called Eulexin (flutamide) which lowers testosterone in just 5 days.
For me cyproterone acetate worked just fine to keep the flare away in three weeks.
Anti adrogens side effects are almost null if taken during short periods like one month.
Wishing the best to your husband,
VGama

PA_grandma
Posts: 48
Joined: Oct 2010

V. Gama.... I appreciate your input. Unfortunately, the more I learn the less I understand. It's really becoming a challenge for me.

To repeat a few facts...
John has received his first (double) and second (single) Firmagon injections during the past two months. He discussed switching to Lupron next and the Urologist agreed.

NO ONE ever told us (except you)... that you should take Casodex for ten days before the Lupron injection on December 16th. What do I do now...??? Is this Doctor incompetent?
Joyce

VascodaGama's picture
VascodaGama
Posts: 1548
Joined: Nov 2010

I would not say that your doctor is incompetent by not providing a drug to avoid flare. Usually the anti-flare drug is a norm in patients with metastases at the lower spine or next to bladder neck, in the intent of avoiding pressure at the disks and obstructive when passing urine. Some doctors do not recommend these drugs if flare is judged to cause no problem on their status, which may be the case of your husband.
My doctor thinks that I have no metastases affecting those areas but as a norm of his own protocol, all patients get an anti-flare before a LHRH. Which doctor is better? Both are good in their belives.
Do not worry so much. Everything will be OK.

Wishing you and John the best.
VGama

VascodaGama's picture
VascodaGama
Posts: 1548
Joined: Nov 2010

I would not say that your doctor is incompetent by not providing a drug to avoid flare. Usually the anti-flare drug is a norm in patients with metastases at the lower spine or next to bladder neck, in the intent of avoiding pressure at the disks and obstructive when passing urine. Some doctors do not recommend these drugs if flare is judged to cause no problem on their status, which may be the case of your husband.
My doctor thinks that I have no metastases affecting those areas but as a norm of his own protocol, all patients get an anti-flare before a LHRH. Which doctor is better? Both are good in their belives.
Do not worry so much. Everything will be OK.

Wishing you and John the best.
VGama

PA_grandma
Posts: 48
Joined: Oct 2010

V. Appreciate your info on the need for Casodex. Sorry for delay in responding.
(I spent two days in emergency after an infected cat bite! Happy Thanksgiving, yeah sure) ~ Joyce

VascodaGama's picture
VascodaGama
Posts: 1548
Joined: Nov 2010

Hope you both have a cozy holiday too.
VGama

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