Rather quick failing of Firmagon

[GSDF]

Hello - I was Dx in 2021 with PSA 480. Firmagon brought it down to 13 but failed after just 6 months. Now on Orgovyx and Xtandi. My concern is the relative quick failing of Firmagon. Would this indicate that the Xtandi will also fail quickly? Thanks!

[Tall_Allen]

It means that castration resistance has occurred. Xtandi and Zytiga were originally approved exactly for the situation you describe.

[EdBacon]

"Would this indicate that the Xtandi will also fail quickly?" Yes, a 6 month run on ADT would indicate that your cancer will not likely respond well to further androgen-based treatments. Based on what I know, it's likely that chemotherapy (Docetaxel) would be a better choice, but since I'm not a doctor you could discuss this with your doctor.

[RyderLake2]

Hello, Not necessarily. After three years my oncologist switched me from Zoladex (goserelin) to Firmagon (degarelix) when my PSA started rising. I was on Firmagon for approximately a year. When my PSA started rising again my medical oncologist took me off Firmagon, put me back on Zoladex and added Xtandi. My PSA went right down to undetectable and has stayed there on and off for the last five years. Nine years and three months later it is still below 2.0. Hope that helps!

[EdBacon in reply to RyderLake2]

So you got 4 years out of ADT alone?

[RyderLake2 in reply to EdBacon]

Yep, The last five years have been Zoladex and Xtandi plus a maintenance dose of Prolia every six months for bone strength. Not bad for a guy whose initial PSA reading was over 1700 with bony metastases all over my body from my neck to my knees. Fortunately no soft tissue involvement although some lesions on lymph nodes. When I meet with my medical oncologist he just shakes his head. I truly am blessed!

[EdBacon in reply to RyderLake2]

Glad to hear.

[MateoBeach]

The easy part is checking whether the ADT drug is doing its job adequately: just check serum testosterone. Castrate level is ideally < 20 ng/dL. Orgovyx works exactly the same as Firmagon, just an oral alternative. If PSA is rising and you have castrate T level, that indicates castrate resistance. You should also be on an AAR drug in addition to ADT, such as abiraterone, darolutamide or Xtandi. Additionally you should consider and discuss adding docetaxel chemotherapy to those two making it “Triplet” therapy. That is known to be the best available approach to de novo metastatic PC, which you were at diagnosis, not terribly long ago. (Though it probably seems like it.)

[GSDF]

Well then, I guess time will tell me true ... I thank y'all and God bless.