Hormone Therapy: ZOLADEX ?

Hello !

I've been on Lupron shots for over a year, then tried two months' worth of Firmagon shots.

My testosterone this past week was still at 26 --- my oncologist wants it to go lower than that, with the hopes of better controlling the PSA by lowering the testosterone even further, if possible.

He thinks we should try ZOLADEX now ---

Does anyone think that Zoladex shots would be superior in any way in terms of suppressing the testosterone levels better than the Lupron or Firmagon shots ?

Has anyone out there had better PSA results from using ZOLADEX instead of Lupron or Firmagon ?

Grateful for any advice on this,
Cyclone

Post Edited (ISU-CycloneFan) : 5/5/2015 5:59:57 PM (GMT-6)

Cyclone,
T=26 is pretty darn good. I know some like to take it below 20, but there are extratesticular sources of testosterone that may prevent that.

Lupron and Zoladex are both GnRH agonists and act in the same way, although some individuals may be more sensitive to one or the other. They both start by encouraging a massive outpouring of testosterone, so massive that your body reacts by shutting the testicles down. There is a testosterone flare before it drops down. Firmagon is a GnRH antagonist that works in the opposite way. The results are usually a little better with the antagonist, but they all get you to about the same place eventually.

The second major source of androgens other than the testicles are the adrenal glands. Ketoconazole and Zytiga act on that and other minor sources by blocking the enzyme that is needed to make androgens. So if you really want to get your testosterone super low, one of those may be a good bet.

There are other strategies too involving estrogen. Putting larger than normal amounts of estrogen into a man's body, as with an estrogen patch, can also serve to turn down testicular production of testosterone.

The important thing is really not your T level (and btw, some think Free T may be a more appropriate measure), but whether the T level is low enough to stop stimulation of the androgen receptors on your cancer cells. If it is, your PSA will fall to undetectable levels. You didn't mention how your PSA has reacted.

There are lots of options to discuss with your oncologist.

- Allen