Does orgovix work if someone is castrate résistant ?

[Wakaka]

Hi All

After casodex, lupron, Xtandi and zytiga, if someone is castrate résistant, can orgovix work and reduice his PSA ?

If yes for how long ?

Best regards

[Hidden]

Its equivalent to a lupron (first line hormonal), just in pill form instead of shots.

[pjoshea13 in reply to Hidden]

However, Orgovyx [Relugolix] is a GnRH receptor antagonist, whereas Lupron is a GnRH receptor agonist.

[Hidden in reply to pjoshea13]

Sorry about the poor metaphor. I edited my original comment to hopefully make it more clear.

[Magnus1964]

It's possible, but after going through all of those other ADT drugs, not likely.

If he does take Orgovyx let us know the outcome.

[Tall_Allen]

It always works, in that it always prevents the testicles from producing testosterone. When castration resistance sets in, you would still take it , because any testosterone makes the cancer grow.

[LearnAll]

Every prostate tumor has a mix of fully androgen sensitive, partially androgen sensive and totally androgen resistant cells. Castration resistance means that the androgen resistant cells have grown very much and androgen sensitive cells has declined in count....But Androgen sensitive cells are still there albeit less of them...Therefore ADT is required even in Castration resitant stage. Its not All or None...Castration resistance occurs on a spectrum. Its only at very very late stage that one becomes 100% castration resistant.

[Ian99 in reply to LearnAll]

Is there a way to measure the level of castration resistance? I have been on ADT now for over 7 years (casodex, zytiga), PSA rising again, am unsure if that qualifies as a very late stage.

[MateoBeach in reply to Ian99]

If you are not on a standard LHRHa drug such as Lupron, Orgovix etc. Then it is unclear if you are truly castrate resistant now. The abiraterone can reduce testosterone to the castrate level, optimally <20 ng/dL, by itself. But this would have to be measured to confirm. The other uncertainty is whether the Casodex has now started to feed rather than block the androgen receptors. This must be stopped and then see if PSA goes down rather than rising.

[Ian99 in reply to MateoBeach]

Pls allow me to clarify. I stopped Casodex after almost 7 years, am now on Zoladex (LHRHa) since Aug/21 and Zytiga since Jan/22. T is steady. Does that make any difference in your view?

[MateoBeach in reply to Ian99]

Thank you, Yes. Presume you stopped Casodex because it stopped working and your PSA was rising on it. Good that you got 7 years with it. But now rising with Zoladex and Zytiga does indicate advanced castrate resistant disease. Most would first try switching the prednisone out for dexamethasone that accompanies the Zytiga. That works for some. Beyond that you must look for non hormonal treatments to add. Chemotherapy, with docetaxel or cabazitaxel. PSMA scan ( plus FDG PET ideally) to see if newly approved 177-Lu-PSMA treatment is appropriate. Provenge also. Xgeva to protect bones. And clinical trials, including possible BAT or immunological treatments guided by genetic analysis. You are not at the end of the road yet, my friend.

[Ian99 in reply to MateoBeach]

Much appreciate explanation of the options. Am awaiting a CT scan to assess met status. Your last sentence is encouraging. Thanks.

[LearnAll in reply to Ian99]

Castration resistance is defined as " Continuously Rising PSA while the Total T is less than 10" Approximate degree of castration resistance can be roughly estimated in first 12 months of ADT. If ADT lowers your PSA by 99.5 % in first year, then the castrate resistance cells were miniscule..i.e. less than 0.5% . But as ADT is used , more and more sensitive cells start becoming castration resistance every passing year. You had been on ADT for 7 years and that means you were very very Androgen sensitive in the beginning.

Sadly, there is no definite way to measure degree of castration resistance after a year of ADT.

[Ian99 in reply to LearnAll]

Ok thanks.

[Mackeyandme]

Only thing that I have noticed is hot flashes and a little difficult to sleep. Otherwise, no issues.

[ishitasen]

Orgovyx (relugolix) is a GnRH receptor antagonist that blocks the pituitary gland from making certain hormones. It is used in advanced prostate cancer to reduce testosterone levels. Few of the studies have found it to be superior to Inj. Lupron is the only drug that is available in tablet form while the rest of the drugs in this category are injectables. Usually, the Orgovys is a safe drug however, there are a few side effects associated with this which involve heart problems and long QT syndrome. Yes, Orgovyx can help in reducing the PSA levels.