So, somebody wrote in and said that they had a Firmagon shot back in March and that they're
still feeling the side effects of it such as hot flashes. Is that normal?
So, we're thinking, what? Four or five months ago, maybe?
The recovery of testosterone when people stop taking Firmagon and stop taking Lupron, Trelstar,
Eligard, is somewhat unpredictable. It is related to people's age, and as men get older,
they have slower testosterone recovery. In fact, some people even risk never getting
their testosterone back. When people stop taking these shots, we always recommend checking
PSA and testosterone every three months to see what the pace of testosterone recovery
is, and if it's really slow, sometimes we even have to talk about giving testosterone
which shocks people because, "hey, well doesn't that grow cancer?" And, yeah, in theory it
can. There have been lots of studies done giving intermittent testosterone or intermittent
hormone blockade showing that it is safe if people are monitored properly. Now, in fact,
with the advent of these PSMA PET scans, one might argue that it's good to give some testosterone
and see if someone who underwent therapy has been cured or not, and if not, find out where
the problem is with a PSMA PET scan. But the issue, now, is that testosterone recovery
is unpredictable and sometimes people can have relatively little exposure to Lupron
and Firmagon and they can have very protracted and extended time periods with low testosterone.
They say it's a one month shot, but a person could have a low testosterone for six months
even after a one-month shot. There's a new medicine out now called Orgovyx, an oral Lupron—so
to speak—that can do all the things that Lupron does—lower testosterone—but one
attraction is that the recovery time period when it is stopped is much more predictable,
and it wears off more consistently than the Lurpon and Firmagon type medicines wear off.
So that's probably a good thing, although, when we look at the studies that have been
giving 4-months of Lupron with radiation or 18-months of Lupron with radiation, it's sort
of baked into the pie that there is going to be an extended recovery time after that.
So, four months of Lupron, really, is on average more like 8 or 9 months of low testosterone.
So, can we just switch our Lupron for Orgovyx? Where you're going to get a true four or five
months of low testosterone, then you're going to be back; will that deliver the same type
of cure rates that historical Lupron cure rates achieve when you would give four months
of Lupron which was really 8-9 months? So, there's a lot of new things that are developing
in the space of suppressing testosterone and the recovery time with Firmagon and Lupron,
bottom-line, is somewhat unpredictable, and sometimes men are left with permanent low
testosterone.
So, when you have a situation like this, does that mean that the fact that the testosterone
is still suppressed, does that mean the drug is working still? Like, they get a shot six-months
ago, is it still having anti-cancer effects?
Well, the anti-cancer effect is delivered by the low testosterone; not by the drug.
So, in a sense, yes. You're getting free Lupron, free Firmagon. The therapeutic effect continues
on as long as the testosterone is low, but the actual medicine itself is long gone. What
happens is that these medicines put the testicles to sleep, and the testicles don't always wake
up consistently after the treatment wears off. So, there's no Firmagon left in the body—there's
no Lupron left in the body—but the recovery of the testicles can be unpredictable after
these medications.
You mentioned Orgovyx. I've seen many patients write in that their doctors have started prescribing
that. I have seen a couple of cases where they're switching from, like Firmagon or Lupron,
to Orgovyx and it seems like that transition is quite tough. Is that accurate to what you've
seen? We've seen some major fatigue issues and things like that.
I can't say that I've seen that; although, my experience with Orgovyx—it's such a new
medicine—is limited. I don't have a sense of whether people are going to feel differently.
Theoretically, they shouldn't, because the main side effects of Lupron and Firmagon doesn't
have anything to do with the medicine itself—other than that Firmagon can cause some rashes on
the tummy when you give injections there—but rather the side effects come from the low
testosterone. Low libido, hot flashes, you know, weight gain; all these sorts of things
are a result not of the medicine, but of the low testosterone that the medicine causes.
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