Add Nubeqa to Orgovyx?

[vintage42]

Age 81. I had prostate radiation in 2021, and pelvic node radiation in 2023. PSA was 3.78 in Dec 2023. PSMA PET then showed cancer growing in prostate, shrinking in pelvic node, but spread to an abdominal node. I have started ADT with Orgovyx (relugolix) and want to add an ARI. The urologist wants to use the ARI Erleada (apalutamide). I want Nubeqa (darolutamide) as it does not cross the blood-brain barrier, because in past 4 years I have had 3 un-diagnosable seizures.

The urologist says Nubeqa (darolutamide) is only for use with the chemo Taxotere (docetaxel), which would be in triplet therapy with an ADT. I see some people are using Nubeqa with Orgovyx, but cannot find anything official on it. Nubeqa is always mentioned with Taxotere.

I there any reason not to combine Orgovyx + Nubeqa as a doublet therapy?

[Tall_Allen]

Nubeqa isn't approved for that indication, only for non-metastatic CRPC or as part of triplet therapy. Your MO may be willing to fight for it on the basis of your seizures, but he may not succeed.

[Aldo62]

I have 4th stage prostate cancer and my Doctor prescribed both medications. There are very few adverse effects from the Nubeqa. Currently, I am taking a break from the ADT and using Nubeqa as a monotherapy. Numbers are holding steady.

[j-o-h-n]

I'm 87 and doc replaced my Casodex with Nubeqa. Still on Lupron however. No side effects and PSA dropped. I think I'm losing my common sense and my sense of humor.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Pianodude]

I have been on Orgovyx and Nubeqa for 18 months. So far it's keeping my PSA below 0.9. Scans show no new metastasis. I had 5 sessions of taxotere right after I was diagnosed almost 4 years ago. My first ADT was Firmagon. Maybe they got away with things because I did have Taxotere, just not at the same time I have been on Orgovyx and Nubeqa.