PSA rising 10 weeks after Orgovyx Holiday

[ac61418]

PCA diagnosed 2018, PSA 6.7, GS 9 (lesions in both lobes of gland, no evidence of metastases), EBRT + Firmagon ADT treatment, ended spring 2019, PSA nadir <0.02 Nov 2019 before rising again. BCR 2022-2023, Pylarify PSMA, Nov 2022 and March 2023 indicates intense uptake areas visible again in the gland corresponding to original lesions that are expanding in size, but no visible metastases.

Began Orgovyx monotherapy in May thru Nov 2023, (6 mos treatment), PSA dropped from 3.3 to 0.05 plateau, Total Testosterone (TT) plateau at 4 and my existing Diabetes was exacerbated by the castrate TT levels.

Only 10 weeks after stopping Orgovyx, PSA now 0.55 ( Ultra sensitive PSA 0.62), TT 114, all spiking up within the last 6 weeks and Diabetes remains out of control.

Very surprised as my MO expected PSA to remain at castrate levels for extended period (8 mos to more than a year) and TT to recover quickly, based on his experiences with other patients who also did 6 mos of Orgovyx monotherapy for their BCR.

Has anyone encountered similar experience(s) with Orgovyx and GS 9 BCR?

I am thinking of asking for another Pylarify scan to see if there is uptake again in the gland and/or visible metastases and if positive, start on Xtandi monotherapy (recent FDA approval for non-metastatic treatment) as Xtandi is not expected to exacerbate my Diabetes.

Any feedback or suggestions are appreciated!