Relugolix/Orgovyx with pelvic radiation?

[bitittle]

My PSA is increasing once again beyond the detectable level. 9 years ago had RPT. 6 years ago had follow up PBRT only upon a detectable psa rise. See history in profile. My recent PSA is at 0.364.

I have a PSMA PET scan scheduled at UCSF in April. Should the scan show metastasis in the pelvic region, I will most likely have pelvic radiation with a short course of ADT.

Has anyone had Relugolix in lieu of Lupron with pelvic radiation?

I like the idea of faster testosterone recovery after finishing Relugolix in comparison to Lupron.

If you have used Relugolix with pelvic radiation what is the course of treatment? How long prior to radiation do you start Relugolix? How many doses(trips to the tube) of radiation for the pelvic radiation?

Thanks in advance Bill.

[Tall_Allen]

I know several patients who have done it. It may not need as much neoadjuvant treatment as with a GnRH agonist (like Lupron), especially with 2 months of radiation therapy.

[bitittle in reply to Tall_Allen]

Thank you Allen!!

[Travelinman]

I did 40 radiation visits with 6 months of Orgovyx at MSK in NYC shortly after the medication was approved for use in the U.S. At that time, my oncologist, who was used to the old ADT wanted to do 2 months of Orgovyx before beginning radiation. But he humored me by agreeing to start the radiation about 6+ weeks (still pretty close to 2 months) after I had started Orgovyx (which by the way, drops PSA faster than Lupron -- which was my point to him). I was eager to be off of Orgovyx and return to normal life, even though I had no side effects due to an extensive exercise (2 hours per day) and penile rehabilitation approach prior to, during and after treatment. I have absolutely no regrets whatsoever regarding my treatment. Life is wonderful! ... so far at least.

[lewicki in reply to Travelinman]

Can you explain penile rehab. Thanks

[j-o-h-n in reply to lewicki]

Electric pencil sharpener... You're Welcome.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 02/01/2023 6:06 PM EST

[Travelinman in reply to lewicki]

Yes. I've had two of the leading penile specialists advising me for a number of years. For the vast majority of that time, I've been under the guidance of Dr. John Mulhall of MSK. Beginning just prior to, during and in the weeks after my ADT treatment (which itself preceded and continued throughout and after radiation), I used Trimix (via injection to the penis) two or three times each week. And, on occasion, I would use Sildenafil (with a break of at least a day or two in between Trimix injections because the mixture can be extremely dangerous to the penis) to test whether I could still respond to Sildenafil (which often isn't the case when using ADT). With the consistent use of these two medications and a hell of a lot of discipline and determination, I had at least three strong erections each week throughout my ADT treatment, and I'm certain that this along with the daily use (7 to 8 years ago) of Sildenafil in the immediate weeks and months following my prior prostatectomy have enabled me to continue to have a very satisfactory sexual life (with the continued used of Sildenafil). A HUGE amount of credit should obviously also go to my surgeon, Dr. Ash Tewari of Mount Sinai of NY and my radiation oncologist, Dr. Michael Zelefsky of MSK. I was virtually panicked about my ability to have a satisfying sexual life prior too my prostatectomy and even more so prior to and throughout my salvage radiation treatment. So far (knock on wood -- pun intended), my expectations have been blown away.

[lewicki in reply to Travelinman]

interesting . Thanks. I will do similar. Not to excited about the injections though.

[SallyJones]

My husband has used Lupron and is still in course of tx. He has not been treated with Relugolix. Sorry, I have no info for you.

[bigdoggatto]

I took Orgovyx for 18 months. I started 4 months prior to radiation treatment. That was EBRT (25 treatments) followed by LD brach. It was easy to add a pill a day to my morning routine. I am one week off medication, hoping for a quick testosterone recovery. Hot flashes were miserable for me. I have no way of knowing if they would have been comparable on Lupron, but I suspect that they would have been. Other than that, I had the usual effects of low testosterone. If I had do this again, it would definitely be with Orgovyx rather than Lupin.

[MateoBeach]

Orgovyx is a fine choice for adjuvant short term ADT with whole pelvic RT. I used it for 6 month course. Why waiting until April for a PSMA scan? If there is no disease seen beyond the pelvis on the scan then treating the pelvic LN fields is the best shot.

[bitittle in reply to MateoBeach]

Thanks for your response.

The soonest a scan can be done at UCSF(closest to home) is March. Unfortunately, I will be out of the country most of the month of March. Hence why April is the soonest I will be available for a scan.

Orgovyx(Relugolix) appears to drop T to a castrate level of <50 ng/dl 4 weeks quicker than Lupron. What appears to be important for the success of ADT with pelvic RT is the amount of time T is held at or below castrate level.

I plan to have conversations with my RO about shortening the overall duration of Orgovyx by a month since it works quicker than Lupron. I would still have T at castration levels for 4 months the same as if I was using Lupron. Not sure I will win the argument but it makes sense to me. We could easily have a T test after one month on Orgovyx to assure T is at castration level.

[lewicki in reply to bitittle]

Think about going the last month. Give it its best shot.

[lewicki]

I have not used it. Not on ADT now but will choose it over Lupron.

[FinnO]

I started Orgovyx on 12/31/22 and did first blood work on 1/17/23. In less than 3wks my T level dropped from 424 ng/ml to less than 3 ng/ml and my PSA dropped from .7 ng/ml to .1 ng/ml. I came into this ADT treatment with a strong fitness level and so far I have had no noticeable SEs other than I lost my "woody". But it's early in the game so I am keeping my head down WRT other SEs. No regrets (so far) on Orgovyx instead of Lupron and I am blessed to be covered by insurance. I start 28 session IMRT for pelvic radiation next week.

[bitittle in reply to FinnO]

Thank you FinnO for the info!

I also have a strong fitness level, so hopefully limited SEs as you have experienced.

Good luck to you brother on the IMRT!

[FinnO in reply to bitittle]

Sure thing bit'. I believe your strong fitness level is going to be a huge plus no matter your choices. Good luck to you as well with choices and treatment!