Goserelin for prostate cancer (Zoladex ®, Zoladex LA ®, Novgos ®)
Goserelin, which is also called Zoladex®, is a hormonal therapy used to treat prostate cancer. Throughout this page we refer to it by its more commonly used name, Zoladex.
You will see your doctor regularly while you have this treatment, so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Zoladex is a hormonal therapy used to treat prostate cancer, breast cancer and some other conditions. This information is about Zoladex as a treatment for prostate cancer.
Hormones are substances produced naturally in the body. They act as chemical messengers and help control the activity of cells and organs. Hormonal therapies work by interfering with the production or action of particular hormones.
Most prostate cancers need the hormone testosterone to grow. Testosterone is produced by the testes and the adrenal glands. Production of testosterone by the testes is stimulated by another hormone called luteinising hormone. This is produced by the pituitary gland in the brain. Zoladex stops the production of luteinising hormone by the pituitary gland, which leads to a reduction in testosterone levels. The cancer cells then grow more slowly or stop growing altogether, and the cancer may shrink in size.
Zoladex is given by injection under the skin of the abdomen (subcutaneously). It is given as an injection every four weeks, or as a longer-acting preparation every 12 weeks (known as Zoladex LA - the ‘LA’ stands for long-acting).
The injections can be given by your GP or practice nurse at the surgery. If you are not able to visit the surgery, a district nurse can give you the injection at home.
Rarely, you may find the injection slightly uncomfortable and notice redness or a darker colour around the area afterwards. You may have a local anaesthetic cream applied before the injection to reduce any discomfort.
Zoladex is given to treat prostate cancer that has spread into the tissues around the prostate gland (called locally advanced cancer). It may also be used to control the growth of prostate cancer in men whose cancer has spread to other parts of the body (advanced or metastatic prostate cancer).
Zoladex can be used alone or alongside other types of treatment. It may be used before or after surgery or radiotherapy for early prostate cancer or locally advanced prostate cancer.
Length of treatment with Zoladex
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Your doctor will discuss with you the length of treatment they feel is appropriate for your situation. Zoladex is often given for several months or even years. Zoladex may be given for as long as it controls the cancer.
Possible side effects of Zoladex
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Each person's reaction to any medicine is different. Some people have very few side effects, while others may experience more. We have outlined the most common side effects here but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor or nurse.
You may have some of the following side effects, to varying degrees.
There may be a temporary increase in testosterone levels for the first few days of Zoladex treatment. Because of this, some men may have an increase in symptoms such as bone pain, or have problems passing urine. Rarely, other problems may occur due to a temporary increase in the size of the tumour. This is known as tumour flare and is normal. It should improve in a few weeks, but if you have any problems, let your doctor know.
Other types of hormonal therapy, such as cyproterone acetate, flutamide or bicalutamide, may be given for the first few weeks of starting Zoladex to prevent tumour flare.
These can be quite common, but many men find that the hot flushes wear off after a period of time. There are a number of ways to help reduce or control hot flushes and sweats. Some men find it helps to cut down on tea, coffee, nicotine and alcohol. Research shows that hormones called progestogens or some antidepressants may be helpful in controlling hot flushes. Your doctor or nurse can discuss this with you.
We have information about hormonal symptoms in men, which might be helpful.
Some men find complementary therapies helpful, such as acupuncture. Your GP may be able to give you details about having these on the NHS.
Loss of sex drive (libido) and erection difficulties (impotence) can occur. These often return to normal after stopping the drug. Some men may find that these problems carry on after treatment is over.
Coping with sexual difficulties can be distressing. Talk to your nurse or doctor if you're having problems. They can give you information and support, and may be able to prescribe drugs to help.
We have a section on sexuality and cancer, which you may find useful.
You may experience mood swings or feel nervous. Talk to your doctor if this continues.
Osteoporosis (bone thinning)
You may be at a higher risk of osteoporosis if you are taking Zoladex for longer periods of time. Your doctor can give you advice on how this can be monitored and treated. Let them know if you have any discomfort in your bones or joints.
We have more information on how you can keep your bones healthy.
Breast tenderness or fullness
You may sometimes notice slight breast swelling and tenderness, known as gynaecomastia. Your doctor can advise you on how this can be prevented or treated.
Some people experience skin rashes. Tell your doctor if this occurs.
Some people may have soreness in their joints, but this is usually mild and will stop when the treatment is finished.
Weight gain and tiredness
You may notice that you gain weight and feel less energetic than usual. This usually improves when hormonal treatment stops.
Change in blood sugar levels
If you are diabetic, your blood sugar levels may become slightly higher than usual and may need more regular monitoring. Your GP or diabetes nurse will be able to help you manage this.
Risk of heart disease and diabetes
There may be an increased risk of developing heart disease or diabetes when taking Zoladex. However, the benefits of hormonal treatment generally outweigh the possible risks. You can talk to your specialist about the possible risks and benefits in your situation.
Always let your doctor or nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
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Missing an injection
Delaying an injection by 2-3 days should not make a great difference. But it's important to remember that the benefits of the injections are designed to last either four or 12 weeks, depending on which preparation you are prescribed. You should try to have them as regularly as possible.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having hormonal treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
This information is based on our Goserelin for prostate cancer fact sheet and has been compiled using information from a number of reliable sources, including:
British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2012).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
With thanks to Kavita Kantilal, E-Prescribing Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.