Goserelin for prostate cancer (Zoladex ®, Zoladex LA ®, Novgos ®)
Goserelin is a hormonal therapy drug used to treat prostate cancer. We have separate information about goserelin for breast cancer.
This information is best read with our general information about prostate cancer.
You will see your doctor regularly while you have this treatment, so they can monitor its effects.
Hormones are substances produced naturally in the body. They act as chemical messengers and help control the activity of cells and organs. Hormonal therapies interfere with the way hormones are made or how they work in the body.
Most prostate cancers need the hormone testosterone to grow. Almost all testosterone in men is made by the testicles. A very small amount is made by the adrenal glands, which sit above the kidneys. Goserelin stops the testicles from making testosterone. This reduces testosterone levels and may shrink the prostate cancer or stop it growing.
When goserelin is given
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Goserelin can be used alone or alongside other types of treatment. It may be used before, or after surgery or radiotherapy. It may also be used to control prostate cancer in men whose cancer has spread to other parts of the body (advanced or metastatic prostate cancer).
Goserelin can be given for months or years depending on your situation. Some men with advanced prostate cancer may have intermittent therapy with goserelin. This involves having goserelin treatment for a few months until the cancer is at a very low level. This level is measured by a blood test called PSA test. You then have a break from treatment and restart goserelin when needed.
Your doctor or nurse will explain how long you have goserelin treatment for.
How goserelin is given
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Goserelin is given by injection under the skin (subcutaneously) usually in the tummy area. It is given every four weeks, or as a longer-acting preparation every 12 weeks.
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.
Some people 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.
Possible side effects of goserelin
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We explain the most common side effects of goserelin here. But we don’t include all the rare ones that are unlikely to affect you. You may get some of the side effects we mention, but you are very unlikely to get all of them. If you are having other drugs as well, you may have some side effects that we don’t list here.
Always tell your doctor or nurse about the side effects you have. They can prescribe drugs to help control some of them and give you advice about managing them.
There may be a temporary increase in testosterone levels in the first few days or weeks after starting goserelin. This may make symptoms caused by the cancer worse. Doctors call this tumour flare. Your doctor may prescribe a hormonal therapy for you to take as a tablet to prevent or reduce tumour flare. You usually begin taking the tablets before starting treatment with goserelin, and continue with them for a few weeks after. If you notice any increase in symptoms in the first month after starting goserelin, let your doctor know.
Hot flushes and sweats
These are common and can be mild or severe. During a hot flush, you feel warmth in your neck and face and your skin may redden. Mild flushes last for a few seconds up to about a couple of minutes. More severe flushes can last for 10 minutes or more. You may sweat, then feel cold and clammy. Some people feel anxious or irritable during a hot flush.
There are things you can try to reduce flushes, such as cutting down on nicotine, alcohol and hot drinks that contain caffeine, such as tea and coffee.
If hot flushes are troublesome tell your doctor. They can prescribe drugs to help reduce them.
Hot flushes and sweats may get less troublesome as your body adjusts to hormonal treatment. They usually stop completely a few months after treatment finishes.
Most men lose their sex drive and have erection difficulties during hormonal therapy. These often return to normal after you stop taking the drug but some men continue to have difficulties after treatment is over. Your doctor can prescribe treatments to help with erection difficulties, but these don’t affect sex drive.
If you need support coping with sexual difficulties, your nurse or doctor can give you information and refer you for specialist support services.
Tiredness is a common side effect. There is evidence that doing exercise and resistance training (such as lifting weights) at least twice weekly can reduce tiredness in men on hormonal therapy. It’s important to get medical advice before starting exercise. Ask your doctor or nurse what is safe for you to do.
If tiredness makes you feel sleepy, don’t drive or use machinery.
Occasionally, people develop a mild skin rash. This often gets better without treatment. Tell your doctor if you have a rash.
Occasionally goserelin can cause sore joints. This is usually mild and stops when the treatment is finished. Tell your doctor if you have sore joints.
Change in blood sugar levels
If you have diabetes, your blood sugar levels may become slightly higher than usual and may need more frequent monitoring. Your GP or nurse will be able to help you manage this.
Possible long term effects of goserelin
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These side effects may happen in some men taking goserelin for longer periods of time.
Weight gain and loss of muscle strength
You may gain weight, particularly around your waist and you may lose some muscle strength. Eating a healthy diet and exercising regularly can help control your weight. Resistance exercises, such as lifting weights, may help you to reduce loss of muscle strength. Ask your doctor or nurse for advice.
Bone thinning (osteoporosis)
Taking goserelin for a few years increases your risk of bone thinning, which is called osteoporosis. This can increase your risk of a broken bone (fracture).Your doctor can give you advice on how this can be monitored and treated. Regular walking and resistance exercises, such as lifting weights, can help to keep your bones strong. Eating a healthy diet, not smoking and sticking to sensible drinking guidelines will also help to protect your bones.
Let your doctor know if you have any discomfort in your bones or joints.
You may experience mood swings. Some men can become low in mood or depressed after taking goserelin for several months or more. Tell your doctor if you notice any mood changes.
Memory and concentration
You may notice changes in your memory or ability to concentrate. Try using a notebook, post-it notes and a calendar to help you keep track of things. If you’re having problems, talk to your doctor.
Breast swelling or tenderness
You may notice slight breast swelling and tenderness. This is called gynaecomastia. Your doctor can advise you on how this can be prevented or treated.
Risk of heart disease and diabetes
There may be an increased risk of developing heart disease or diabetes when taking goserelin. But, 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. Eating a healthy diet, not smoking, staying within the recommended limits for alcohol, keeping to a healthy weight and being physically active can help reduce your risk.
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.
Missing an injection
If an injection is delayed by 2-3 days, this should not make a great difference. But you should try to have your injections as regularly as possible.
Goserelin can interact with other drugs. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including ones you can buy for yourself, complementary therapies, vitamins and herbal drugs.
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking goserelin. Explain you are taking hormonal therapy, and that no one should stop or restart without advice from your cancer doctor. Tell them the name of your cancer doctor so they can ask for advice.
This information has been produced in accordance with the following sources and guidelines:
British National Formulary. www.bnf.org/bnf/index.htm (accessed June 2014)
electronic Medicines Compendium (eMC).www.medicines.org.uk (accessed June 2014).
NICE clinical guideline 175. Prostate cancer: diagnosis and treatment. 2014.
If you’d like further information on the sources we use, please feel free to contact us.
With thanks to Kavita Kantilal, E-Prescribing Pharmacist, who reviewed this edition.
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