After 6 weeks only on orgovyx my PSA has dropped to 1.175 from 21 and testosterone to 25 from 400.
Are these numbers ok ?
I read many here say their testosterone numbers are much lower - in single digits. Hence I am wondering if I should switch to Firmagon and see if they drop more.
Do testosterone and PSA numbers drop more once an ARPI is added ?
Your PSA Halving Time is about 10 days, which isn't for the Guinness book of records, but surely not failing the drug either. Take it for a month longer and see if it gets lower to 0.3 or not.
If it does not get to 0.3 , I should try another antagonist you reckon ?
No, IMO, Orgovyx has distinctive advantages. Adding an Anti-Androgen would be my choice, although I would started the other way round: Anti-Androgen first and if unable to do the job brink Orgovyx to supplement.
Don’t most people add the anti androgen after the ADT ?
In the US, yes. My guess is that this had to do with the extra income of docs injecting the drug vs prescribing tablets. Now, with Orgovyx and the second generation ARSI, where the money factor is comparable you see "studies" surfacing saying that Enzalutamide mono therapy is better than ADT alone and the combo is the best. "Follow the money" provides good guidance.
what about trials showing doublet being more effective than just ADT ?
In my language we have this saying that goes back very deep in the ancient Greek literature: Freely translated: "More isn't better" Our cancerous loads are not comparable, I am high risk BCR, but non metastatic. 1/10 standard dosage of 1st gen ARSI Bicalutamide just resulted this week in a PSA reading of 0.006.I am not the typical PCa patient. I am the odd one out but happy with my results.
You need to understand where these recommendations come from. They come from academic centers where doctors make salaries and don’t make extra money from injecting drugs. In addition this same formula is used in countries with national health care where they do not make extra money injecting drugs. As a physician I have met a few doctors who would actually think that way but it is a real minority. Most are just trying to do the best they can. Maybe not too smart or not well informed but in general their heart is in the right place.
T below 30 is great, especially this fast.
I read below 20 is the best ? It would go down further beyond 6 weeks ?
definitely headed in the right direction my friend.
The ARSI might be added but usually in a different setting, ie, recurrence or resistance... A discussion with your team as to whether or not it's a good choice right now. Treatment lines are important to preserve if not necessary, so they may be used later when needed.
When Orgovyx failed (for me) and I switched to injectable Degarelix, my PSA stabilized, it didn't drop back to undetectable until adding the cell receptor inhibitor Darolutamide! Then it (PSA) dropped like a rock and has stayed there.
Problem is twofold, one being that what worked for ME, doesn't mean this path is for YOU.
Second is that although Multimodal therapy has shown higher efficacy in control, the question is whether or not this is best for you at this time. Always a conundrum... But honestly, you've left too much of your story from your post in order to understand where you are along your journey.
All the Best!
I mentioned some of my story in the bio. Diagnosed with metastatic to bones only In may. Initial psa 21. Orgovyx since 6 weeks. Psa now 1.75. Gleason 9. Doctor wants me to start on 80 mg xtandi to start with .
Isn’t the latest Thinking to hit metastatic cancer hard at the start rather than the earlier 1 by 1 approach
We thought the same thing, but after 3 opinions from top doctors in the country, it's better to start with Doublet to shrink the Mets, then talk about radiation. My husband has a similar bio to you - just diagnosed this past May. PSA 21, then 24 a month later, then 36 3 weeks later. Gleason 9. Mets to pelvic bones and lymphs.
Current plan: Orgovyx, which dropped his T from 347 to <10. PSA dropped to 2.7. Doctee was very encouraged by those numbers. Just added Nubeqa. Will retest in a month. If it's still dropping, another PSMA scan in December then we'll decide on radiation. Good luck!
Thanks. Was that drop inT and psa 6 weeks after starting orgovyx.
My worry is that chemo if needed later on may not be as effective.
It was 3 weeks after starting! Our docs told us there is no data at all to support starting chemo early is the way to go. Some believe it is so that we can be more aggressive, but show us the data. Of course, this mindset changes if there's any generic abnormalities. We are still waiting on those results to come back.
your response is great. There will be a variable amount of Testosterone produced by the adrenal gland. That will go away with the abiraterone.
My opinion darn good. I have been on orgovyx myself along with nubeqa for 5 month just got my psa results 0.44 last mo 1.04 , I would expect you will be like me below 1 on the psa soon. I think Orgo did most of the lowering only been on the Nubeqa for 3 mo.
I highly recommend that you stay the course with Orgovyx.
My story is that I began Orgovyx 12/10/21 when my PSA was 30. On 1/24/2022 my PSA was 1.85. 2/24/2022 PSA was 0.25. 4/2/22 began taking abiraterone. on 4/24 PSA was undetectable, and has remained that way through my latest PSA test on 7/25/2024.
I have had very few side effects with some fatigue and brain fog, but way less than friends who are on Lupron. Also highly recommend the addition of abiraterone/Zytiga to the Orgovyx ASAP.
I am 77, but other than my PCa am in fairly good health. I only take 5mg of prednisone daily which has not caused any health issues. Don't know how xtandi compares to abiraterone but TA probably can tell you.
PARP inhibitor Olaparib, phase 3 study findings (PROpel)Don't take it as medical advice: training routine
MRI prior to HDR Brachy and HDR intensity.
PSA holding low!!General health (also not bad for PC): a fasting-mimicking diet reduce insulin resistance, liver fat, immune system aging, and biological age
