Questions for 2nd Meeting with MO tomorrow about reaction to 2 months on Orgovyx and Zytiga

[PBnative]

Just read all replies to question about ADT and castration resistance . Feeling a bit overwhelmed . Started 2 months ago with a Firmagon shot then added Zytiga and switched to Orgovyx pills instead of Firmagon injection . I start 26 sessions of radiation on 1/6. They said the size of my prostate even after 12 years of Avodart precludes me having brachytherapy.

RO and MO said they can treat me with “ curative intent “ as shown in STAMPEDE trial. Diagnosis is “ high risk ( due to PSA 61 ) localized non -metastatic ( based on PSMA -PET scan and bone scan ) PCa with SVI and “probable “ lymph node involvement .My Gleason score was 3-3 in 2009 biopsy . They did not require a new biopsy unlike Johns Hopkins , which wouldn’t treat me without a new biopsy.They are recommending Orgovyx for 18 months and Zytiga with prednisone for 24 months .

When I voiced concerns about CRPC the docs said that’s only an issue if the radiation and systemic therapy fail. Does this make sense?

My PSA is down from 45 2 months ago to 1.8 . So far the only side effects are irritating hot flashes .

I’m going to ask him if I need 4 Zytiga tablets on an empty stomach when one pill with food is as effective and has less side effects.

Does anyone have suggestions for othernthings to ask the MSK MO?

Thanks in advance for any comments or suggestions .

[Javelin18]

Hi, I’m reading between the lines that they are planning to irradiate the prostate and possibly the lymph node with the intent of killing all the cancer. They might have you continue on ADT to kill any cancer that isn’t visible on the scans.

I think the statement about CRPC not being a problem means if they kill all the cancer with radiation and ADT, there isn’t any cancer to become resistant.

I would ask how what they ate planning to irradiate, and what type of therapy. They can irradiate the pelvic region, or just the visible lesions. I would also ask how long they plan to have you on ADT.

I take 4 abiraterone on an empty stomach. Food changes the absorption, and taking without food produces a know serum level. Taking less with food may yield the same serum level, but it may not be as easy to ensure the level is the same.

[PBnative in reply to Javelin18]

Thanks for sharing . I will ask them for details about the radiation treatments. I already know they’re prescribing Orgovyx for 18 months with Abiterone ( continuing for a full 24 months.)Tall_Allen suggested in his response that I ask the MSK MO about a clinical trial testing a shorter ADT regimen .

[Tall_Allen]

Please read my recent reply to Waiffette10, whose fiance is in a similar situation.

healthunlocked.com/advanced...

MSK is a site for NRG-GU-009, so definitely ask about it.

"When I voiced concerns about CRPC the docs said that’s only an issue if the radiation and systemic therapy fail. Does this make sense?" Yes. You are going for a cure with ADJUVANT hormone therapy. CRPC is only a concern with lifelong hormone therapy

"I’m going to ask him if I need 4 Zytiga tablets on an empty stomach when one pill with food is as effective and has less side effects." You misunderstood the study. It does NOT say that side effects are less. It is only a scheme to save money on Zytiga - much less of a concern now that abiraterone generic costs $250/mo. Food increases absorption so that the absorbed dose is roughly the SAME as 4 pills on an empty stomach. It is the absorbed amount that dictates the side effects. Because absorption varies with the meal and with the person, you get better dosing with the 4 pills.

[PBnative in reply to Tall_Allen]

Thanks, TA . Very helpful input , as usual . I’d love to have a shorter ADT regimen. Woke up 4 times last night in a sweat . So far hot flashes are the main side effect . Having one as I write this . They’re irritating but manageable. I know there are more pernicious side effects over time .

[PGDuan in reply to PBnative]

I was on ADT+Zytiga for 18 months. The hot flashes seemed the worst during the first few weeks on ADT and then they seemed a lot less frequent and bothersome. Good luck!

[Tall_Allen in reply to PBnative]

They do seem to diminish over time. Estrogen, Megace, Venlafaxine, acupuncture, or oxybutynin help some.

[PBnative in reply to Tall_Allen]

Thanks again

[j-o-h-n]

Who is your M.O. at MSK?

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/17/2021 10:29 PM EST