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Firmagon vs Lupron during Salvage Radiation

Posts: 127
Joined: May 2017

PSA 22, RP in October 2016, Gleason 7 (4+3), negative margins, seminal vesicle involvement, negative lymph nodes, PSA did not become undetectable (lowest was 0.3) and then started rising rapidly, doubling every 2 months. Bone scan and pelvic CT scan negative after rising PSA. Decided on salvage radiation therapy along with hormone therapy for 6 months with 2 months of radiation in the middle. Opted for Firmagon to start with my first double shot almost a month ago. Second shot due next week.

I have the option to stick with Firmagon or switch to Lupron for the remaining 5 months of HT. Had new PSA/testosterone blood tests this week and obviously the results might steer the decision. So far on Firmagon:

Injection site pain (manageable)

Hit by a Mack Truck the day after a shot (rough day but then its over) 

Weight gain/excercise intolerance (working on it)

Sweating (manageable)

Fatigue (manageable)

Loss of libido (kind of a riddle because you also don't care as much. :-))

Dizziness (manageable)

Insomnia - Whoa, this is the hardest part. The insomnia started at week three. I have a hard time going to sleep (almost always up until 3AM) and then wake up suddenly 2 - 6 times a night and into the morning. This may also explain the fatigue and getting winded during excercise. Here are my questions:

1) For you other Firmagonians out there, if you had insomnia did it get better or worse in the later months?

2) For those of you that have been on both Firmagon and Lupron (or one of the other agonists), which had the side effects that were easier to tolerate?







GeneRose1's picture
Posts: 64
Joined: Aug 2016

George, I had surgery to remove my prostate in April 2014. By October of the same year the cancer had returned & I started six months of Firmagon injections with one shot per month plus two months of radiation treatment. For me, the Firmagon caused a significant weight gain and Type 2 Diabetes. It also caused the cancer to disappear for about 18 months. The cancer started coming back again last year & in February 2017 I began receiving Lupron injections. I've had much more success with Lupron. Sure, I have hot flashes, fatigue, and bone pain but I'm better prepared for it and exercise as much as  I can to ward off the worst of the side effects. That's just my experience and hope you have much better results than I did with the Firmagon.

Posts: 127
Joined: May 2017

I just got my blood tests back. At week 3 my testosterone is 33 and my PSA has become undetectable so Firmagon is doing it's job but my liver enzymes are out of bounds already so I'll have to discuss that with my Rad Onc Monday. They forgot blood glucose so I don't know my sugar status yet. On Monday I have to decide if I stay on Firmagon or switch to Lupron.

VascodaGama's picture
Posts: 2929
Joined: Nov 2010

My experience is with Leuprolide (Lupron, Eligard, etc), however, both drugs (Lupron and Firmagon) got similar side effects because both cause hypogonadism (low levels of testosterone) which condition is linked to the major effects one experiences. Some guys have reported to lesser intense effects with Firmagon probably due to the difference in which these drugs do their job. Firmagon is an LHRH antagonist and Lupron is an LHRH agonist. Both work at the pituitary to avoid this gland from sending down the signals for manufacturing of androgens. Firmagon glues itself to the SFH cells. Lupron imitates the SFH flooding the system with orders. This makes the pituitary to stop working. In other words, while on Lupron our pituitary is in constant havoc, which can lead to blurred vision, problems in recognition or temporary loss of memory. Mood change is typical. Hypogonadism is behind the hot flashes, fatigue, low libido, anxiety, irritability, insomnia, joint pain, loss of muscle mass, loss of body hair, etc.

The best to counter these effects is by changing our life style. Earlier dinners, afternoon naps, walking and physical exercises for creating muscle, and diet.

Your testosterone level at 33 ng/dL means it being working properly. T can still go lower in time.

Best wishes for successful salvage therapy,


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