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Different Hormone Therapies

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User
Posted 17 Jun 2021 at 19:14

I was diagnosed with metastatic disease in my lymph nodes following a robotic prostatectomy in September 2017. I was prescribed Decapeptyl, (six monthly injections), as well the usual 6 session course of chemo.  However, when my next 6 monthly Decapeptyl injection was due in May 2020, because of the COVID situation in UK, I found myself stuck overseas where Decapeptyl was unobtainable but, fortunately COVID was not rampant.  Fortunately I was able to source 3 monthly Zoladex and my UK based consultant oncologist said that would work fine, which it has done.  My PSA has been undetectable since I started the treatment regime in September 2017.  I also checked my testosterone just to make sure the Zoladex was working as well as the Decapeptyl did - it was!!  I am shortly to go back to UK and am trying to decide whether to revert to Decapeptyl or stick with Zoladex.  Of course, I will talk to my oncologist but wondered if colleagues on this forum who are in a similar boat to me might have read any research on the effects of changing hormone therapies after a period of time on one type.  Specifically, does it help or hinder or does it simply not matter?  Any pointers towards relevant research would be appreciated.

User
Posted 18 Jun 2021 at 19:04
No, there isn't. Once the GnRH fails, you wouldn't be able to change to another GnRH that would work for a bit longer, etc. The main issue with changing is in side effects - if you are tolerating decapeptyl well, you might be reluctant to change back to Prostap if the side effects of that were worse for you.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 18 Jun 2021 at 20:16

Yes, it's helpful to understand that the GnRH Agonists (and GnRH Antagonists for that matter such as Degarelix/Firmigon) don't act on the cancer at all. They act on the pituitary to cause it to stop asking the testicles to produce testosterone, just like you were temporarily castrated. When they stop working, it's because castration is no longer working to control the cancer, and it doesn't matter how you are castrated - you became castrate-resistant.

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User
Posted 17 Jun 2021 at 21:08

Zoladex (Goserelin), Prostap (Luprorelin), and Decapeptyl (Triptorelin) are all GnRH Agonists and work the same way. They should be interchangeable for the main effect. Do be careful of the dose durations though. Prostap is 3 months, Zoladex 12 weeks, and Decapeptyl 12 or 24 weeks. (1 month or 4 week doses also available.)

Some people get slightly different side effects, so it's probably not a good idea to switch unless there's a reason.

My GP surgery prefers Zoladex as it results in fewest injection site issues. The 24 week Decapeptyl has become popular during COVID because of fewer trips to the surgery. Some surgeries always use whatever is the cheapest at that moment.

User
Posted 18 Jun 2021 at 17:32

Thanks. Yes, I realise they all do the same thing but they are slightly different chemical compounds so I just wondered if there was any evidence that a change in GnRH argonist  may lengthen the time they are effective - grasping at straws probably!  As far as I can judge the side effects I get from both Decapeptyl and Zoladex are pretty much identical. 

User
Posted 18 Jun 2021 at 19:04
No, there isn't. Once the GnRH fails, you wouldn't be able to change to another GnRH that would work for a bit longer, etc. The main issue with changing is in side effects - if you are tolerating decapeptyl well, you might be reluctant to change back to Prostap if the side effects of that were worse for you.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 18 Jun 2021 at 20:16

Yes, it's helpful to understand that the GnRH Agonists (and GnRH Antagonists for that matter such as Degarelix/Firmigon) don't act on the cancer at all. They act on the pituitary to cause it to stop asking the testicles to produce testosterone, just like you were temporarily castrated. When they stop working, it's because castration is no longer working to control the cancer, and it doesn't matter how you are castrated - you became castrate-resistant.

 
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