OK, a little good news , what is next?

[rick8637]

A quick background after BRT 3 yrs ago. Psa rise to 18 in march, pet scan shows small mets. 3 bone and one lymph node. Firmagon for 1 month in June and switch to Orgovyx. Psa test in sept shows a rise to 27.98. MO says do another test in six weeks. Today it is 19. Now we are getting somewhere right?

Can I assume now I am castrate sensative? I was getting myself geared up for xtandi or zytiga on top of ADT but now I feel i may not need it and maybe should stay the course?

No pain just hot flashes and feeling ok and exercise daily. I want to be proactive!! I think this site is the best broad form of info out there!!

[GP24]

If you want to be proactive I would add Zytiga. It should make you live longer. A PSA value of 19 is too high to do just plain ADT.

[rick8637 in reply to GP24]

Thanx for the thought. If it dropped 30% in 6 weeks would you not expect it to keep dropping. MO did suggest she might have me do Zytiga even tho psa is dropping. That also requires Provenge too for liver enzymes right? I liked the Xtandi idea a little better (one drug, no liver issues) but eeny meeny miny mo. This stuff is a foreign language to me..

[GP24 in reply to rick8637]

You add Prednisone to Zytiga. Zytiga plus ADT will lower testosterone more than just ADT and thus stop the PCa growing. Your insurance will prefer Zytiga.

[rick8637 in reply to GP24]

Prednizone!! sorry,my brain fade..

[Tall_Allen]

The lack of a total PSA response to Orgovyx shows that there is some castration-resistance going on. This opens the field to a several of different therapies. The fact that your bone metastases were not visible on a bone scan puts you in a category called "non-metastatic castration-resistant PCa." There are 3 drugs approved for this: Erleada, Nubeqa, or Xtandi.

[rick8637 in reply to Tall_Allen]

So under these circumstances you would see xtandi a better choice over zytiga for a combined treatment with orgovyx.? I have an appoint with MO in a week and will pass this along.

[Tall_Allen in reply to rick8637]

I didn't say that. Zytiga is not indicated for non-metastatic CRPC, while the 3 drugs I mentioned are indicated.

[rick8637 in reply to Tall_Allen]

OK I get it, xtandi would be the more " indicated" therapy.? So this category " Non- metastatic CRPC" is because mets were not found in a CT bone scan even tho they were found later on a PET scan? Is that based on the size of the mets then? just Trying to wrap my head around this..

[Tall_Allen in reply to rick8637]

Nubeqa, Erleada or Xtandi are indicated. I didn't say they were "found later on a PET scan." I said they might have been found on a PET scan if it had been used (as in your case). PET scans detect different things than bone scans. This article explains it:

prostatecancer.news/2016/12...

[meowlicious99 in reply to Tall_Allen]

> category called "non-metastatic castration-resistant PCa."

I am shocked to know that such a thing exists. Had to read that twice.

[Atlpapa in reply to Tall_Allen]

so if traditional CT and bone scan show nothing but a PET scan (not sure which one he had) shows mets it is still considered non-metastatic for treatment plans? I didn't realize that. That seems bad in a way because they are there just not big enough to see on traditional scans.

[Tall_Allen in reply to Atlpapa]

That is correct. It was because the benefit of those 3 medicines was proven in clinical trials among men with no detectable metastases on a bone scan/CT who were castration-resistant (rising PSA while on ADT). All of those men probably did have metastases if PET scans had been used.

I look at it as a good thing-- it makes 3 medicines available to patients earlier than they otherwise would have been. Nubeqa and Erleada would otherwise be unavailable to CRPC men.

[rick8637 in reply to Tall_Allen]

Well I think that answers all my current questions. I will choose one of these "amide" drugs with the help of my MO . They all have similar side effects from what i see(aarg) but the outcomes are 70% better than using ADT alone. Too bad there is no generic version yet, these drugs are pricey!

What a great site this is for me.. so helpful

[Schwah]

I’d add Zytega now. This chart illustrates the advantage.

Survival advantage of Adding Zytega to ADT