My Dad , 83 , with bone mets has started bicalutamide since a week and is soon to take the Lupron shot. But he has a fear of injections as many years back he has developed an abscess due to an injection wrongly given.
Is orgovyx as effective as the injections in reducing testesterone ?
One doctor I asked dismissed orgovyx and said not as effective but online I am reading other things.
Are there any studies done on this ?
Orgovyx/Relugolix was approved on the basis of the HERO study: nejm.org/doi/full/10.1056/N...
Thanks. Wonder why my doctor said that !
I suspect your doctor thinks Orgovix/relugolix is less effective than injectable ADTs is that since it is a pill taken daily it is easier for a patient to be “noncompliant”. (forget to take a pill -and with Orgovyx , timing is important-same time every day). Much more control fot the physician to monitor compliance when they are giving injections once a month ot three.
Plus administering the injection is clinic revenue that pills don't bring in. Always a possibility in this world of choice.
I have done both 6 month Lupron injections as well as Orgovyx. My experience, which may not be typical, was that the hot flashes I experienced on Lupron were much lower with Orgovyx.
Did you have any other side effects with both ?
The other significant side effect I experienced was reduced libido, which is very common for both Lupron and Orgovyx.
"In this trial involving men with advanced prostate cancer, relugolix achieved rapid, sustained suppression of testosterone levels that was superior to that with leuprolide, with a 54% lower risk of major adverse cardiovascular events."
just a comment not directly related to your query. Has your dad’s doctor been asked for a frank answer to what the effect of treatment will be on life expectancy at age 83? Will it improve it and at what cost in terms of drug side effects?
I am 78 retired doctor with mets and I am not convinced by the data for those over about 75. Fine if you are 70 or less but after that ask what is the real benefit ( other than to pharma and your docs job)
Do you mean to say to do no treatment ? I know man who was diagnosed at 90 with several mets , including liver - he just did an Orchiectomy and lived 4/5 years more , quite well mostly.
No treatment is always an option. It is up to each individual to weigh up the balance between reduction in quality of life from side effects, plus hospital and physician visits and tests versus taking no treatment. It is too easy with fear of cancer into taking therapy without considering the whole cost benefit equation.
ADT has all sorts of side effects to take into consideration. Eg weight gain, muscle loss, metabolic syndrome, (hyperlipidaemia, diabetes, cardiovascular disease), cognitive effects, osteoporosis etc….
In the case of your 90 year old, who is to say that orchiectomy made any difference to the outcome?
well I understand what you are saying. But bone pain is often reduced just by ADT like in the case of that 90 year old.
You have made me curious. Can you tell me your diagnosis and what choice you made.
78 yrs old. Now have early PET+ve mets in bone no symptoms. ADT played havoc. Androgen receptor blockers like enzalutamide seemed to offer no benefit in terms of life expectancy over about age 75. Hospital visits tests etc - anxiety provoking and time consuming
So living life to full and if I beat 80 I will be more than happy. If I need pain control consider options on merits eg shot of local radio, analgesia whatever.
We don’t live for ever so carpe diem!!
So you taking absolutely nothing ? Never considered an Orchiectomy. Less stressful
I started ADT with Orgovyx 6 months ago at age 81. After 1 month my rising PSA dropped from 3.78 to 0.38 (now 0.03 but have added Abiraterone). The side effects of Orgovyx were negligible for me.
What side effects did you have
So have been on Orgovyx for 6 months and Abiraterone/Prednisone for 4 months, so effects are combined.
Mental: Gradually increasing "brain fog". Not as good at remembering a sequential plan, doing several things at one time, doing complex tasks accurately the first time. Often forget that I started doing something, should not put something on the stove and then go off to do something else. Thinking seems slower, more reflective. Making To Do lists is more important.
Physical (compounded by not exercising either before or now): Gradually feeling weaker, have to exert more to do yard care. Muscle converting to belly fat, with no gain in weight. Stronger appetite but reduced metabolism, must reduce portions. Recent lower leg cramps at night (believe from the Abi/Pred). Believe I am also becoming little clumsy, less careful with hands, knocking things. Could be age, too.
But overall -- not unpleasant, very tolerable, good quality of life considering.
I did 12 months Orgovyx, just completed on 3 April.
If you want to give the benefit of doubt to his doctor, then go with Lost_Sheep 's comment. It does require patient discipline to take every day at approximately the same time versus a shot once every one, three or six months.
As others have pointed out, it does generally have some medical advantages:
Faster suppression of testosterone.
Higher sustained castration while on it.
Faster recovery of T when stopping.
Lower CV side effect profile.
As to the side effects, generally the same as Lupron (which I did for 18 months) since both suppress T to castrate levels with all that encompasses, hot flashes, fatigue, muscle and joint stiffness, loss of libido, genitalia shrinkage..are they less "severe" than Lupron, my experience was "yes" but they still sucked..
It may have financial toxicity depending on insurance.
Not saying, but there are financial disadvantages to the doctor since they do not get to bill for the "cost" of a lupron shot which includes the Lupron and administration.
So, you could go back to his doctor, discuss the studies such as TA and GP 24 pointed out and see if he changes his mind. If not, you and your father have a choice to make, fire him and go somewhere else or...
Kevin
I am on Orgovyx and Nubeqa for about 3 months, few hot flash not bad no real SE's. Early on I told my doctor No injection type ADT and No Predisone. My onco doc agreed it would be ok providing I didn't miss dosing. So far good results rapid psa drop , Next month blood work will tell more. Only problem for me was insurance drug plan coverage resolved with co pay and grants. my onco doc has an in house pharmacist she made the calls and assisted in obtaining assistance. Best
I think more of us would like to switch from the injections, be it Lupron or Firmagon...problem is the cost of Orgovyx is extreme...for me anyways
Yes I take nothing - I eat and drink what I want, lead a very active life. No worries about weight gain etc!😀
What was your Gleason ?
Exercise is key! I’m on Orgovyx and Xtandi. Warm up with cardio and do plenty of weight lifting and other resistance exercises.
Yes very important- especially resistance to build muscle bulk and to protect bones
did you get my reply? Gleason 6 both sides. Radical prostatectomy 2009, biochem recurrence 2012 radiotherapy pelvis, recurrence 2023.
Yes I did. Thank you 😊
Tinkudi, I've been on Orgovyx for over three months now. After two months, my PSA dropped from 16.8 to 1.45. My next blood test is in three weeks. So, I can attest to its effectiveness. I elected Orgovyx because the idea of injecting 3 to 6 months of medicine into my body, all at once, seems a very bad idea. It's no wonder people can have dramatic skin reactions to the injections. Monthly doses would seem more reasonable. However, I like the control I have taking a daily pill and knowing that recovery of T will be more rapid when I go on holiday from ADT (after my RT). Granted, I'm paying approximately $700/mo with my Medicare Part D plan, so there's a price. That cost is coming out of my HSA account for now. My source is one that my RO tracked down called ONCO Specialty Pharmacy, located in Louisville, KY. SEs have been tolerable, to date. They're all the ones you read about.
doctors have a tendency to stick with what they learned in medical school and are slow to adopt new protocols or new medication. It is basically the “run what you brung” mentality.
Orgovyx was approved by the FDA in 2020, so it is a newer medication than Lupron which was approved in, if I recall correctly, 1984.
the only drawback I have seen in medical journals about Orgovyx is that taking the daily pill at the same time every day is essential and sometimes patients do not follow that schedule as well as they should. seems to be a critical failure point in treatment.
if you want to avoid almost all of the side effects of androgen deprivation therapy that have been mentioned so far in this thread, and you can find a provider to prescribe it, consider the therapy being tested in the United Kingdom in this study: Prostate adenocarcinoma transcutaneous hormone (PATCH) study.
In every parameter where there is a difference, the difference favors the treatment being tested except gynecomastia which can be easily prevented and is merely cosmetic and mastodynia, which is transient
Effects on the gut and heart of Orgovyx (Relugolix) vs Lupron 
Orgovyx
ADT with Orgovyx
Orgovyx overdose
