They work in different ways but both starve the Prostate cancer cells of testosterone as a fuel.
Bicalutamide stops the cells using testosterone by blocking their ability to bind to it.
Prostap and similar drugs work by stopping the testes from producing testosterone.
There are three main ways to have hormone therapy for prostate cancer. These are:
- injections or implants to stop your testicles making testosterone
- tablets to block the effects of testosterone
- surgery to remove the testicles or the parts of the testicles that make testosterone. This is called an orchidectomy.
The type you have will depend on whether your cancer has spread, any other treatments you’re having, and your own personal choice. You may have more than one type of hormone therapy at the same time.
Injections or implants
You may hear this called androgen deprivation therapy (ADT). These work by stopping your brain from telling your body to make testosterone. Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.
Injections and implants are both given using a needle. Injections are given in a similar way to having a vaccine, where a small amount of liquid is injected under the skin or into the muscle. If you have injections, you will have them in your arm, abdomen (stomach area), thigh or bottom (buttock),depending on which type you’re having. Ask your doctor or nurse whether you will have injections or implants. Implants are given using a larger needle to place a tiny tube under the skin of your arm, which slowly releases the drug.
You will have the injections or implants at your GP surgery or local hospital – once a month, once every three months, once every six months, or once a year. How often you have them will depend on the type of hormone therapy.
LHRH agonists
LHRH agonists (luteinizing hormone-releasing hormone agonists) are the most common type of injection or implant. There are several different LHRH agonists, including:
- goserelin (Zoladex® or Novgos®)
- leuprorelin acetate (Prostap® or Lutrate®)
- triptorelin (Decapeptyl® or Gonapeptyl Depot®)
- buserelin acetate(Suprefact®).
LHRH agonists cause the body to produce more testosterone for a short time after the first injection. This temporary surge in testosterone could cause the cancer to grow more quickly for a short time, which might make any symptoms you have worse – this is known as a flare.
If you’re having an LHRH agonist, you’ll be given a short course of anti-androgen tablets to stop any problems caused by this surge of testosterone. You’ll usually start taking the anti-androgen tablets before having your first injection or implant and continue taking them for a few weeks.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
The ‘back pain, pelvic pain, joint or muscle pain’ is down to the body feminising - the muscles lose tone and ligaments soften, the pelvis spreads (as it would in a pubescent girl) etc etc.
Never heard of stinging pains being associated though ... would want to have a check for infection instead, I think
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Hi, I've just started on bicalutamide 150mg. If there is bleeding in the urine can anyone tell me how quickly after starting the drug the it occurs
User
I've never heard of bicalutamide causing bleeding in urine.
If you get blood in urine that's not explained by a recent biopsy or which your clinical team are not already aware, you need to mention it to them, even if just once.
User
Not a side-effect I've ever heard of anyone reporting.
Chris
User
Started Bical just under a week ago, so still early days but since Day 1 have felt increasingly weak and swimmy most of the time. Feels a lot like flu or hayfever without the sneezing and coughing. No pains as yet but walking is becoming more difficult as my thigh muscles seem to be steadily weakening. Overall it's quite debilitating.
However I note no one else appears to have reported the flu-like symptoms so maybe it's just a coincidence and what I'm suffering really is flu or hayfever. If so it's years since I last had these symptoms.
User
Probably got covid (not joking)
User
Tbh I'd kind of dismissed the possibility of covid until you mentioned it, so thanks for the heads up! Pleased to say I have now taken the test which was negative.
So the flu/allergy like symptoms are presumably just a coincidence, though maybe I'm a little more susceptible because my immune system has been weakened?
Will ask about this when i go to Lister my injection in a week's time.
User
Good morning folks. I've been on the Bical 50mg tabs for 12 days now and few serious side-effects really (mind you I have partied fairly often the last 2 weeks and kept a posiitve attitude) - so first injection on Thursday (day 15) then keep taking the Bical for another 14 days.
I've asked for the Decapeptyl (as reportedly there are less side effects) one but so far my GP hasn't confirmed which one I'll get yet (which is worrying and a bit annoying) ..... my question is: How long after the first injection will the side-effects kick in please?
User
Hi Howard I specifically asked for Decapeptyl after following others. To be honest the hot flushes started in days. The drop of libido is weird and noticeable but not too bad. I’m like 20 months into it and still want some and can manage it with Cialis. Aches and pains start in joints. Memory fog quite an issue. I’ve had zero weight gain nor moobs. In my opinion things get amplified over time even if they are there from the start. Eg my fatigue is worsening each month I feel. Good luck with it ok 👍
User
Many thanks Chris - your positivity is always good to read! GP practice has just called, and after initially saying they didn't use Decapeptyl they say that they now have it! - so that's a bonus ... as is they say they are going to give me the injection in the bum! ... I'm hoping that the nurse is pretty too! ... sorry, a bit non-PC but being a bit flippant about the whole thing helps me to cope. :-)
Although I'm quite a bit older than you (I've just turned 63) I'm heartened to read that you've still been able to manage it even after 20 months (Well done Sir!) and no moobs either - although I'm imagining that senstive nipples might be a bit of a turn on!? Anyway, not that I've got a girlfriend at the moment (but still working on it - and being honest about my condition) ... not that: 'I've got to use it or lose it! ... errr maybe you could help me?" seems to be working as a chat up line .. yet! :-) Anyway, am taking the 'Use it or lose it!' mantra seriously and have managed to achieve orgasm for just about every day of the 12 days I've now been taking Bical and have arranged a date for Weds night! ..... on the grounds that at 9.15am on Thurs morning might be the herald of RIP to my sex life.
User
Love your positivity and candour. It’s definitely needed when tackling all this rubbish. Yes you are older I know but a lot of it is state of mind and you obviously want to keep active, so keep doing what you’re doing. I swear pump use has saved my little fella in these 7 years and kept him tip top. Keep positive 👍
User
Originally Posted by: Online Community MemberGood morning folks. I've been on the Bical 50mg tabs for 12 days now and few serious side-effects really (mind you I have partied fairly often the last 2 weeks and kept a posiitve attitude) - so first injection on Thursday (day 15) then keep taking the Bical for another 14 days.
I've asked for the Decapeptyl (as reportedly there are less side effects) one but so far my GP hasn't confirmed which one I'll get yet (which is worrying and a bit annoying) ..... my question is: How long after the first injection will the side-effects kick in please?
Hi Howard, I'm in much the same boat as you. I have advanced PCa and started a 4 week course of Bicalutamide 150mg on 21 July, followed by an injection of Decapeptyl 3mg IM on 2 August.
Side effects kicked in within 24 hours. I felt REALLY peculiar, dizzy, very weak etc for about 24 hours, but the next day I was much better and to my amazement by Day 3 all side effects from the injection seemed to have washed away and it's been pretty much plain sailing ever since. Just the occasional swimmy head and slight weakness.
Next injection will be a much-increased dose (11.25mg) of Decapeptyl on 30 August, so will have to see how that goes.
Best of luck to you for your injection, hope it all goes smoothly and you get relatively minor side effects.
Do please keep us posted.
Tony
User
Hi,
I've now had 2 of the 3 monthly injections, next is due end of September 2022.
Just wondering if anyone is suffering joint pain? Mostly in the knees, however, it also
affects my other joints. It also seems to move around, from one wrist to the other. Knee
pain is continuous though!
I'm being prescribed medication (Diclofenic), Anadin Extra, neither of these help the pain at all.
Anyone help?
Regards,
Peter
User
Joint pain is a common side effect of HT - swimming may help
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Been on decapeptyl for 14 months odd bit off shoulder pain but generally tolerable 👍
User
Permanent knee pain. Had osteoarthritis previously but has worsened since on HT. I soldier on and keep painkillers to a minimum if I can
User
Commenced HT on 21 July with Bicalutamide and have had two Decapteptyl since, first was a 4-week one at the beginning of August, second a 12-week one at the end of that month.
Plenty of symptoms so far, notably regular hot sweats and spells of very debilitating weakness c/w a swimmy head lasting several hours every few days, but cannot say I've had any real joint pain as such.
I do also regularly get a weird, uncomfortable tingling sensation on the back of my hands on waking up in the morning but does not last long and is only very lightly painful.
User
The last two nights I have had a skin crawling sensation at night, which made it very difficult to sleep and I would guess I have been waking up at least 20 times a night. I have been on Bicalutamide hormone blocker since early March this year and have just completed around 10 days ago, a one month's pelvic radiotherapy treatment at the Preston Park department of the Sussex Cancer Care Centre. I am considering asking my GP for short term sleep assistance.
User
Hormone therapy can cause itching with no obvious visible issue on the skin. One consultant told me this is because it can cause fat to be deposited in nerve sheaths and the itching is referred pain, but I've never read that anywhere. I had it on both arms a couple of times - usually lasted about a month and then went away.