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Firmagon: Issues with long-term treatment?

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Posted 4/4/2017 7:12 AM (GMT 0)
Friends,

Two years ago I switched to Firmagon because of the very convincing mechanism and efficacy of the drug. The initial Testosterone suppression was excellent (2.5ng/dl). The only issue I kept having was the swelling at the injection site. Usually that is gone after about a week - but some injections left a bit of internal scar tissue.

Now, after two years of Firmagon it gets increasingly difficult to find a location that does not have such scar tissue. If an injection hits such tissue it seems that the distribution of the depot is uneven. So far, that was not a big concern. But recently, as my PSA started to rise again, we recently measured my T-level and it showed that it was not as low as it was right at the beginning of the treatment. Still a good suppression (10 ng/dl) but not as low as it could be.

So here's my question: Has anyone else had longer-term issues with Firmagon and what did you do about it?

Thanks, m.
Posted 4/4/2017 11:34 AM (GMT 0)
I never had Firmagon. Knowing others who have, and hearing accounts like yours, it seems to be a somewhat difficult to administer.

Our forum member grandpaof4 has been on Firmagon for a couple of years now, I believe. Maybe he has some advice?

For what it's worth, Lupron is quite easy. I had 6 month injections, so far apart I'd forget which side they last injected. A mild bruise sensation for a day or so, then nothing. My T was checked only a couple of times while on it, and was always less than 10.

Have you considered switching? I'd think once your T is well-suppressed by Firmagon, it would take longer than Lupron's initial cycle to recover. In other words, could you change over without your T level rising?

Just a thought. Maybe ask your doctor about it? You're on ADT for the duration it looks like from your signature. The six month interval was pretty nice.
Posted 4/4/2017 4:37 PM (GMT 0)
I was only on Firmagon for a few months. At the end of my two years of ADT I switched from three month Trelstar depots to one month Firmagon shots. I had a theory that I might recover more quickly with a GNRH antagonist than with an agonist and that one month shots ought to wear off faster than three month shots.

So, I can't speak to your question about long-term effects but I do sympathize with the injection-site problems.

At 10 ng/dL your testosterone remains pretty well suppressed but I can't see any compelling reason not to change to an agonist HT drug if you think that would help. You might want to ask your MO if there is any possibility of a T flare during the switch-over. My suspicion would be that between the lingering effect of the Firmagon and the Casodex you should be pretty well protected.
Posted 4/4/2017 8:28 PM (GMT 0)
Redwing, Peter,

Thanks for your input! Yes, a switch back to an agonist HT drug may well be an option. Initially I started my ADT with Zoladex (goserelin). First with the one month depot (which worked well) and then with the three month depot. The latter did not work so well, the T was almost unsupressed in month 3 and my PSA started to rise. That's when I switched to Firmagon. With Firmagon my T-level dropped almost immediately to a new low (and the PSA did the same). That was very successful, so I am a bit hesitant to switch back to an agonist.

Anyhow, next step is to have another test of my T-level one week after the injection of the Firmagon to get a better idea of the dynamics of my T-level between two shots. I will then decide with my MO what we will do next. The goal will be to bring the T down as low as it has been in the past and hope that this will stop the increase of the PSA level.

Best, m.
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