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Degrilex or zoladex ??

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Prostate Cancer
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Posted 6/15/2013 12:37 PM (GMT -5)
looking for some advice here guys.I have to go back on ADt as my PSA has gone over 100 after a break of 9 months off zoladex.Lymph nodes in groin area have swollen badly and urologist is telling me that removal is not an option.My oncologist has done new bone scan and a ct scan of my complete abdomen.The onco wants to give me degralix instead of zoladex as there is no tumour flare with this drug compared to zoladex.Can anyone tell me the difference in how the two drugs work and compare experiences Ect ??.Are the side effects the same in both instances?I have to get ADt as I have no other real options at the moment but I'm scared of the dizziness and depression I experienced whilst on zoladex for two years previously.
Posted 6/15/2013 2:23 PM (GMT -5)
Lee,
If you think you might be permanently place on hormonal therapy, then it is reasonable to think about orchiectomy. The men I know that had them actually were glad they did. This will get rid of any need for a GnRH or LHRH agonist, or antagonist. But by doing so you also may start a new regimen on bicalutamide, but also look into Zytiga or TAK700 to suppress testosterone production through the adrenal glands. These drugs shut down the CYP17,18 pathways as well.

There is currently a clinical trial in the US testing TAK700 against bicalutamide.

Tony
Posted 6/15/2013 6:02 PM (GMT -5)
Leeangelo,

Zoladex is a similar drug to Lupron. It is a gonadotropin releasing hormone superagonist (GnRH agonist). In small doses it increases the production of Teststerone. In large doses it initially increases it and then shuts it down almost completely. That initial increase is the testosterone "flare" your oncologist is worried about. Degralix is a GnRH antagonist. It works the opposite way to do the same thing. It suppresses the production of Testosterone directly and does not have any initial opposite reaction.

We have a couple of guys here who have had an orchiectomy. You might want to compare notes with them before you pull the trigger on that. The Degralix will wear off eventually (probably) when you stop it but orchiectomy is kinda permanent. I think ralfinaz may have written about them. He has an email address in his profile
Posted 6/15/2013 6:19 PM (GMT -5)
Lee,
Agreeing with Peter, the orchiectomy is permanent and should be only considered for guys that are told no more vacations from HT. But at that point they can be ideal. With a PSA over 100 after just nine months on the vacation, it is quite likely that your doctors won't want you to take another vacation. At that point getting the shots is just a hassle. But whether you consider that rout or not, it is likely that it's a good idea to consider some of the newer secondary HT routs as well.

Tony
Posted 6/16/2013 6:02 AM (GMT -5)
Lee, here is Dr.Myers´very informative video on Firmagon (Degarelix). There is a study (Univ. of Colorado) that actually shows overall survival time is longer on Firmagon than other similar medications. That is in addition to the benefit of no-flareups.

askdrmyers.wordpress.com/2013/02/27/firmagon/
Posted 6/16/2013 11:20 AM (GMT -5)
Thank you all,if Dr myers says it's a good drug then I will be happy to give it a go.Hopefully the side effects will be lesser than with Zoladex.Really couldn't cope with the dizziness zoladex was causing....hot flashes Ect were bearable but feeling dizzy every afternoon was driving me mad.
Posted 6/16/2013 12:21 PM (GMT -5)
Leeanglo,
These drugs will have similar side effects as they suppress testosterone and the SEs are consequence of testosterone suppression. I had an orchiectomy and do not recommend it as long as these other drugs are available and do not represent a financial or physical burden to the patient. An orchiectomy is irreversible while all these drugs are not.

Firmagon being an antagonist as compared to Zoladex, Lupron, etc that are agonists has an initial advantage of not inducing a testosterone flareup but a disadvantage of having to be injected every month. Since you had major SEs with Zoladex this might be an advantage if you need to stop therapy while on Firmagon. Wish you the best outcome.

RalphV
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