Additional Drug Choice

[jcarey79]

I started my ADT treatment with Eligard and Xtandi but had to change due to the cardiovascular side effects. I have been on Orgovyx alone for 10 months. My PSA is undetectable and my testosterone is 13. The drug is doing what it should. Side effects are hot flashes, fatigue, weight gain, and muscle loss.

My oncologist would like me to add Xtandi, Zytiga or Erleada to the Orgovyx regimen as he believes it could extend my life by up to 40 months. Obviously, I am in favor of that. But my question is: Given that my PSA is undetectable and Testosterone is at 13, what will the additional drug do?

Also, does this group have an experience taking Orgovyx with any of the three drugs and, if so, what has this been like for you?

Thanks,

[Tall_Allen]

It is a common mistake to think of PSA as being your cancer. It is only a biomarker, a very good one, but therapies for PCa are evaluated on how much they add to survival, not by how much they reduce PSA in the short run. For example, a STAMPEDE trial compared abiraterone + ADT to ADT alone. They both reduced PSA, but the combination reduced it for a longer time and provided a longer survival time.

[jcarey79 in reply to Tall_Allen]

That makes sense, thank you!

[d3is4me in reply to jcarey79]

Jcarey79 Abiraterone & ADT is good

[Boonster in reply to Tall_Allen]

TA, is 2 years on Orgovyx a sufficient salvage treatment protocol, if both PSA AND testosterone are dramatically reduced -- say non detectable for PSA and 5 for testosterone?My MO at John Hopkins is ready to switch me to active surveillance when I reach 2 years on Orgovyx, since my blood tests as described above are encouraging Thanks, as always, for your informed comment. Boon

[Tall_Allen in reply to Boonster]

This may help you decide:

prostatecancer.news/2023/02...

[Boonster in reply to Tall_Allen]

Very valuable, especially along with your post about Xtandi. Thanks so much.

[garyjp9 in reply to Tall_Allen]

TA, in the STAMPEDE trial for newly diagnosed men with positive lymph nodes, did they stop taking the Abi + Pred after 2 years and continue with ADT alone for another year? Stopping the one and continuing with the other is accepted practice?

[Tall_Allen in reply to garyjp9]

Yes.

[garyjp9 in reply to Tall_Allen]

Thank you, TA

[tango65]

I would discuss having Zytiga or Nubeqa, which are usually better tolerated than enza or apalutamide. Since you had cardiovascular problems , Nubeqa (darolutamide) could be first choice. They will prolong life.

[SeattleDan]

Although I had prior cardiovascular problems on a Lupron & Erleada combo, I’m now on an Orgovyx & a (slightly-reduced dosing of) Erleada. It’s been a year now with near-zero PSA, quite low T, and few known side effects other than hair loss and scrotum shrinkage. Though of course I wonder some about what’s ahead, so far, so good.

[SeattleDan]

My Mets are in lymph nodes only, however. And I exercise a good bit.

[Hidden]

my two cents. Research and then talk to your Medical Oncologist about micro-metastasis. On 2004, my MO, a Researcher and Professor on Genitourinary Diseases walked in and said that it didn’t matter if I had a surgery or radiation, it didn’t matter. Don’t second guess yourself as you already had micro-metastatic cancer cells in your body upon original diagnosis floating and traveling your vascular and lymphatic systems.

I don’t hear much about this, however I was told that systemic treatment was the way the kill these little unseen bastards

I can’t tell you about new and improved systemic treatment; only that for me that meant a chemotherapy trial with ADT (Lupron/Eligard) for six months. I remained on this line of ADT for 6 1/2 years before “testing the waters” without the injections.

Others can tell you about the many trials and results along this line over the last 19 years. I can not.

I do you wish the the best in killing the little bastards.

Final point, I never worried about side effects. Most can be managed. I recognized that I had a terrible disease and my life changed as a result.

Gourd Dancer

[turkeyjoe1 in reply to Hidden]

What is systemic treatment? My PSMA scan came back clear but URO says I have micro Mets floating around that can't be seen yet. Sending me to another Doc for 4 different choices of drugs. Ztiga will be the one I choose from what TA and the stampede trial shows.I start IMRT April 7. On Lupton 7 months. Gleason 9 DX PSA 106 now at .47

[Hidden in reply to turkeyjoe1]

My explanation appears above your post and answered in this thread. Systemic means whole body. Therefore, Systemic Treatment uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Add lymphatic system as well.

I can’t tell what is “new and improved”, because I have no experience nor knowledge. I can only go with what I was taught in 2004. Hopes this helps..... you might read the entire thread for a better understanding.

GD

[lincolnj8]

Been 5 years for me. 4 1/2 years on zytiga. It's very pricey but if you're not rich there are foundations that will help you. Pan is one, Johnson and Johnson may still help. I don't have all the answers. My psa was 850 5 years ago. And a prednisone-zytiga combo worked for me. Hope this helps.

[watertender]

Interesting, I have been on Orgovyx for about a year now, high risk Pca. Initially my original MO declined to add a 2nd gen drug since my scans were clear however I was unable to get a PSMA scan before my PSA had dropped to low. I really wanted to add another drug for micro mets so contacted 2 different MOs for their take, one at UCLA and my current new MO at UCHealth in CO.

What I have heard from both is they felt at this point there was no benefit in adding another drug so I find it interesting to hear varied opinions on this. My PSA and T are both currently undetectable so maybe that is why they are saying no and saving it for down the road use. Both stated there would be an increase in side effects if another drug was added, I have enough trouble with brain fog as it is so that is another consideration. They are also recommending stopping ADT at 2 years if numbers are favorable.

Good luck on your decision!

[jcarey79]

Thank you for all the input. Very helpful to read your experiences.

John